Objective: To compare the clinical efficacy of minimally invasive closed reduction and open reduction and internal fixation in the treatment of ankle fractures. Methods: 133 cases with ankle fractures were selected.They were divided into closed group (65 cases) and incision group (68 cases) according to random table method.The closed group was treated with minimally invasive closed reduction, and the incision group was treated with open reduction and internal fixation.The therapeutic effect, amount of bleeding, time of fracture healing, time of operation and postoperative complications were compared between the two groups. Results: The good rate of the closed group (98.46%) was higher than that of the control group(85.29%, χ²=7.594, P<0.05). The amount of bleeding in the closed group[(19.40±3.56) mL] was less than that in the incision group[(39.84±4.15)mL], the fracture healing time in the closed group[(10.24±2.15)weeks] was shorter than that in the incision group[(15.46±3.67)weeks], the operation time in the closed group[(38.94±8.71)min] was shorter than that the incision group[(59.38±13.25)min](t=30.424, 9.950, 10.462, all P<0.05). The incidence rate of postoperative complication in the closed group (1.54%) was lower than that in the incision group (16.18%, χ²=8.675, P<0.05). Conclusion Minimally invasive closed reduction in the treatment of ankle fractures is better than open reduction and internal fixation, and has important research value.