[Objective] To investigate the clinical outcomes of syndesmotic screw combined with platelet rich plasma (PRP) for treat- ment of distal tibiofibular syndesmosis injury. [Methods] From June 2018 to July 2019, a total of 96 patients with ankle fracture and distal tibiofibular syndesmosis injury were enrolled in this study, and were divided into two groups by random number table method. Of them, 48 patients received tibiofibular screw fixation combined with local PRP injection (the PRP group) , while the other 48 patients received tibio- fibular screw fixation only (the non-PRP group) . The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation done successfully without serious complications. Although there were no significant dif- ferences in operative time, incision length and preoperative VAS score between 2 groups (P＞0.05) , the PRP group proved significantly su- perior to the non-PRP group in terms of intraoperative blood loss, postoperative drainage volume, swelling and petechial grades 3 days post- operatively, as well as incision healing, VAS score from 24 hours postoperatively to discharge, time to return walking postoperatively and hospital stay (P＜0.05) . The follow up period lasted for more than 12 months. The PRP group resumed full weight-bearing activity signifi- cantly earlier than the non-PRP group (P＜0.05) . The VAS scores significantly decreased (P＜0.05) , whereas the AOFAS score and plantar flexion-dorsal extension range of motion (ROM) significantly increased in both groups at the latest follow up compared to those preopera- tively (P＜0.05) . The PRP group was significantly superior to the non-PRP group in aforesaid items at the latest follow up (P＜0.05) . Radio- graphically, the tibiofibular clear space (TFCS) and medial clear space (MCS) significantly reduced (P＜0.05) , while the tibiofibular overlap (TFO) increased significantly in both groups at the latest follow-up compared with those preoperatively (P＜0.05) , which in PRP group were significantly better than those in non-PRP group at the latest follow up (P＜0.05) . [Conclusion] Tibiofibular screw fixation combined with PRP for distal tibiofibular syndesmosis injury does alleviate early postoperative injury reaction, accelerate ligament healing, and benefit functional recovery.