Abstract: Objective: To compare the advantages and clinical efficacy of fixed fibula in open reduction and internal fixation of double tibial and fibular fractures. Methods: The clinical data of 54 patients with double tibia and fibula fractures admitted to the Department of Orthopedics and Hand Surgery of Ruikang Hospital affiliated to Guangxi University of Chinese Medicine from January 2018 to January 2020 were analyzed. According to the preoperative doctor-patient communication results, 29 patients used fixed fibula and 25 patients had unfixed fibula. Perioperative, follow-up, and imaging data were compared between the two groups. Results: All patients were uneventful and no intraoperative complications occurred. The intraoperative fluoroscopy times in the fixed group were significantly less than that of the non-fixed group (P<0.05), and the first postoperative touch time in the fixed group was significantly earlier than that of the non-fixed group (P<0.05), but the operation time and total incision length were significantly higher than those of the non-fixed group (P<0.05). There were no significant differences in intraoperative blood loss, incision healing, and hospital stay in the two groups (P>0.05). All patients received complete follow-up, lasting from 12 to 18 months. Complete weight-bearing activity time in the fixed group was earlier than that in the non-fixed group (P<0.05). At the 3-month postoperative follow-up, VAS score, HSS score and AOFAS score were higher than the non-fixed group (P<0.05), knee extension-flexion and ankle back-plantarflexion ROM were greater than the non-fixed group (P<0.05), VAS score, HSS score and AOFAS score were higher than the non-fixed group (P<0.05), and knee extension-flexion and ankle back-plantarflexion ROM were higher than the non-fixed group (P<0.05). Compared with the last follow-up, the VAS score, HSS score, AOFAS score, knee extension-flexion, and ankle dorsal extension-plantar flexion ROM improved significantly compared with the previous group (P<0.05). Postoperative imaging showed that the excellent rate of fracture reduction in the fixed group was significantly higher than the non-fixed group (P<0.05), and the image fracture healing in the fixed group was earlier than the non-fixed group (P<0.05). Conclusions: Fixed fibula is a significant advantage in open reduction and internal fixation of double tibibular fractures, with excellent results.