[Objective] To evaluate the clinical efficiency of the posterolateral combined with the posteromedial approaches for open re- duction and internal fixation (ORIF) of posterior malleolus fractures. [Methods] From July 2017 to June 2020, 29 patients received ORIF of Haraguchi type Ⅱ posterior malleolus fractures through the posterolateral combined with the posteromedial approaches in our department. Clinical and imaging documents of the patients were evaluated. [Results] All the patients had the operation performed smoothly, with opera- tion time of 72~123 min with a mean of (85.2±18.7) min and the intraoperative blood loss of 30~80 ml with a mean of (47.4±23.8) ml, and good incision healing. All of them were followed up for 15 to 34 months, with an average of (20.1±3.5) months. The AOFAS score, VAS score and ankle range of motion significantly improved over time postoperatively (P＜0.05) . Radiographically, the quality of fracture reduc- tion was excellent in 24 cases, good in 5 cases and poor in 0 case, with an excellent and good rate of 100.0%. All the patients got fracture healed in 11~15 weeks postoperatively, with grade 1 ankle degeneration in 3 patients, which was not significantly different among each time points after operation (P＞0.05) , however, no fracture displacement, fracture nonunion and internal fixation loosening were noted in anyone of them until the latest follow-up. [Conclusion] The posterolateral combined with posteromedial approaches is fully exposed posterior mal- leolus fractures, which is conducive to fracture reduction and fixation with satisfactory function recovery.