[Objective] To explore clinical outcome of locked intramedullary nail in treating distal fibula fracture with lower tibiofibular syndesmosis injury. [Methods] From January 2019 to February 2022 , 29 patients with distal fibula fracture and lower tibiofibular syndesmosis injury were respectively analyzed. Operation time, intraoperatve blood loss, incision length, postoperative complications, and reduction of lower tibiofibular syndesmosis were recorded. [Results] All patients were followed up for (13.7±2.4) months. The average operation time, blood loss, incision length were (51.8±10.3) min, (68.3±14.3) ml, (42.5±3.6)mm. No incision infection and necrosis. Breakup of the lower tibiofibular screw occurred on 1 patient. One patient was transferred to cardiology department because of acute atrial fibrillation. The AOFAS score, VAS score and ankle range of motion significantly improved over time postoperatively(P<0.05). Regarding imaging, compared with those preoperatively, tibiofibular overlap(TFO)[(8.1±1.3)mm,(8.0±1.1)mm vs (2.1±0.7)mm, P<0.05] and tibiocrural angle(TCA)[ (83.1±3.0)mm,(82.4±2.9)mm vs (73.9±4.2)mm, P<0.05] both increased significantly at 6 months after operation and the latest follow-up, however, tibiofibular clear space(TFCS) significantly decreased[(4.3±0.5)mm,(4.4±0.5)mm vs (8.3±1.3)mm, P<0.05]. [Conclusion] For patients with distal fibula fracture and lower tibiofibular syndesmosis injury, locked intramedullary nail is consistent with anti-rotation, minimal invasive incision, less bleeding, effective fixation of the lower tibiofibular screw and other advantages.