Abstract: [Objective] To explore the clinical effect of anterior lateral combined with medial minimally invasive plate osteosynthesis technology (MIPO) approach for the treatment of distal tibial pilon fractures. [Method] 115 cases of distal tibial pilon fractures admitted to our hospital from March 2019 to May 2022 were randomly divided into an observation group of 58 cases and a control group of 57 cases by drawing lots. They underwent anterior lateral combined medial MIPO approach surgery and anterior lateral approach surgery, respectively. Compare the two groups of surgical, serological, imaging, and follow-up related indicators. [Result] The surgical time in the observation group was significantly longer than that in the control group (P<0.05), and the intraoperative blood loss, hospital stay, fracture healing time, and complete weight bearing time were significantly lower than those in the control group (P<0.05). The levels of serum osteocalcin (BGP) and bone alkaline phosphatase (BALP) in the observation group were significantly higher than those in the control group at 1 week and 3 months after surgery (P β Special sequence（ β- The level of CTX was significantly lower than that of the control group (P<0.05). There was no significant difference in the total incidence of complications between the two groups after 3 months of reduction and 12 months after surgery (P>0.05). The range of motion (ROM) and American Association of Foot and Ankle Surgeons (AOFAS) scores of the observation group were significantly higher than those of the control group at 3 months after surgery (P<0.05), and the pain visual analogue score (VAS) score was significantly lower than that of the control group (P<0.05). There was no significant difference in ROM, VAS score, and AOFAS score between the two groups at the last follow-up (P>0.05). [Conclusion] The anterior lateral combined with medial MIPO approach for the treatment of pilon fractures of the distal tibia has minimal trauma, can promote ankle joint reduction and functional recovery, and shorten fracture healing time.