Abstract: Objective The effects of micro-locking plate and headless compression screw in oblique fracture of the medial malleolus were compared to provide optimal therapeutic plans. Methods A total of 44 medial malleolus fracture in our hospital from April,2013 to January,2015,including 27 males and 17 females,age raged from 20 to 67 years old with average of (42.6±26.3) years old,were retrospectively analyzed.The causes of fracture included sprain (n=23),sports injury (n=16) and traffic injury (n=5).For combined injuries,there were 7 cases with double ankle fractures and 5 cases with trimalleolar fracture.All fractures were close injuries.The durations from injuries to operations were 4 h to 3 d.Based on different options for internal fixation,the patients were divided into two group,Group A (n=18;fixation with micro-locking plate) and Group B (n=26;fixation with headless cannulated screw).The fracture healing rate,incidence of complications,and the American foot and Ankle Society ankle hindfoot score (AOFAS Ankle-Hindfoot Scale) were evaluated by outpatient follow-up and X-ray. Results All 44 patients were followed up for 12-18 months[an average of (13.9±3.4) months].The fracture healing time was 10-16 weeks with an average of (12.4±0.9) weeks.There was no case with wound infection and poor healing and no complications,such as breakage or Loosening of internal fixation,and nonunion of fractures.According to AOFAS ankle and hindfoot score,the average score of group A and group B was 92.8±5.6 and 93.0±4.7 points respectively.Compared with the preoperative,the functional score significantly increased.But it showed that there was no statistically significant difference between the two groups (P>0.05). Conclusion For oblique fracture of the medial malleolus,both micro-locking plate and headless compression screw can provide effective stump pressure and better clinical results.However,screw technique shows superiorities of low cost,feasibility of percutaneous fracture reduction and less dissection of soft tissue.It is a safe and effective method,which is worth of clinical application.