[Objective] To compare the clinical efficacy of absorbable versus metal screws for internal fixation of Maisonneuve frac-tures. [Methods] A retrospective study was conducted on 31 patients who received surgical treatment for Maisonneuve fractures in our de-partment from January 2020 to October 2021. Based on preoperative surgeon-patient discussion, 15 patients had internal fixation with ab-sorbable screws, while the remaining 16 patients were with metal screws. The perioperative, clinical and imaging documents were comparedbetween the two groups. [Results] There were no significant differences in operation time, total incision length, intraoperative blood loss, in-traoperative fluoroscopy times, incision healing grade and hospital stay between the two groups (P＞0.05). All patients in both groups werefollowed up for a mean of (19.2±4.6) months, and the absorbable group resumed full weight-bearing activity significantly earlier than themetal group [(70.4±8.6) days vs (84.6±5.6) days, P＜0.001]. As time went by, the AOFAS score and ankle dorsal-plantar flexion ROM inboth groups increased significantly, while the VAS score decreased significantly (P＜0.05). At 3 months after surgery, the absorbable groupproved significantly superior to the metal group regarding ankle dorsal-plantar flexion ROM [(42.5±3.6)° vs (38.2±4.9)°, P=0.009], whereaswhich turned to be no significant difference between the two groups at 12 months after surgery and the last follow-up (P＞0.05). In addition,there were no statistically significant differences in terms of AOFAS and VAS scores between the two groups at any time points accordingly(P＞0.05). With respect to imaging, there was no statistically significant difference in postoperative fracture reduction quality between thetwo groups (P＞0.05). Compared with those preoperatively, the medial clear space (MCS) and tibiofibular clear space (TFCS) in both groupssignificantly declined (P＜0.05), while the tibiofibular overlap (TFO) increased significantly at the last follow-up (P＜0.05), which proved notstatistically significant between the two groups at any matching time points (P＞0.05). At the last follow-up, all patients in both group got theinjury healed well with on a statistically significant difference in healing time between them (P＞0.05). [Conclusion] The absorbable screwfixation does achieve similar clinical consequence with the metal counterpart for Maisonneuve fracture, however, the former has advantages of early weight-bearing exercise and no need for secondary surgery to remove the implant over the latter.