BACKGROUND:Clinical treatment of tibiofibular syndesmosis separation of unstable ankle fractures can be treated by surgical internal fixation method. The internal fixation process can choose different materials, in the past, most of the operations used metal pul ing nail, but there may be broken nails and other risks. OBJECTIVE:To explore the application effect of traditional metal pul ing nail and macromolecule absorbable screw fixation in tibiofibular syndesmosis separation of unstable ankle fracture. METHODS:The clinical data of 63 patients with tibiofibular syndesmosis separation of unstable ankle fractures who received surgical internal fixation treatment in Affiliated Hospital of Shaanxi University of Chinese Medicine from February 2013 to February 2014 were retrospectively analyzed. Patients were divided into metal pul ing nail group (n=32) and absorbable screw group (n=31) according to the use of different materials. The fracture end was reset by cutting from the outside of the lower section of the fibula. The steel plate was used for fixation. The traditional metal pul screws and macromolecule absorbable screw were used for fixation. During the 12 months of fol ow-up after internal fixation, the ankle function scores of two groups (Baird-Jackson), clinical effect and the incidence of adverse events were observed and compared. RESULTS AND CONCLUSION:The average ambulation time and hospital stay of patients after internal fixation in absorbable screw group were significantly less than those of metal pul ing nail group (P<0.05). The ankle joint function scores (Baird-Jackson) in these two groups were increased compared with those before surgery, but the difference was not significant (P>0.05). The excel ent and good rate of patients in absorbable screw group was significantly higher than that in the metal pul ing nail group (P<0.05). During 12 months of fol ow-up after internal fixation, one patient had screw breakage in metal pul ing nail group. There was no wound infection among patients in these two groups. These results confirm that the use of macromolecule absorbable screw fixation for the treatment of tibiofibular syndesmosis separation of unstable ankle fractures can obtain better application effect compared with the traditional metal pul ing nails.