[Objective] To compare the clinical efficacy of absorbable screw and metal screw fixation in the treatment of Maisonneuve fracture. [Methods] Clinical data of 31 patients with Maisonneuve fracture admitted to our hospital from January 2020 to October 2021 were retrospectively analyzed. All patients underwent open reduction and internal fixation. 15 cases were fixed with absorbable screws and 16 cases were fixed with metal screws. The perioperative, clinical and imaging results were compared between the two groups. [Results] There were no significant differences in operation time, intraoperative blood loss, total incision length, incision healing and hospital stay between the two groups (P>0.05). The average follow-up time was (19.2±4.6) months. The time to complete weight-bearing activity in the absorbable screw group was significantly shorter than that in the metal screw group (P<0.05). As time went by, the AOFAS score, ankle O-M score and ankle dorsal-plantar flexor ROM in both groups were significantly increased, while the VAS score was significantly decreased (P<0.05). At 3 months after surgery, the ankle dorsal-plantar flexion ROM in the absorbable screw group was significantly higher than that in the metal screw group (P<0.05), and there was no significant difference between the two groups at 12 months after surgery and the last follow-up (P>0.05). At the same time point, there were no significant differences in AOFAS score, VAS score and ankle O-M score between the two groups (P>0.05). At the last follow-up, there was no loosening or displacement of the screws in the two groups, and there was no statistical significance in the overall alignment of the ankle (P>0.05). There were 3 patients in each group with grade 1 degeneration, and the difference was not statistically significant (P>0.05). [Conclusion] The curative effect of absorbable screw fixation in the treatment of Maisonneuve fracture is similar to that of metal screw fixation, which can be used for early weight-bearing exercise without the need for secondary surgery.