Objective To compare the short and long-term effects of different approaches in the treatment of distal tibia post-pilon fractures. Methods A retrospective analysis was carried out in 29 patients with distal tibia post-pilon fractures. They were divided into group A ( postmedial approach, n =16 ) and group B ( anterolateral approach,n=13) according to different operative approaches. The length of stay,healing time,postoperative complica-tions and excellent and good rate of hip functional recovery in the two groups were compared. Results There were no significant differences in length of stay and bone healing time between the two groups(all P>0. 05). There was no significant difference in the incidence rate of postoperative complication between the two groups(6. 3% vs. 23. 1%,χ2 =1. 708,P>0. 05),but the incidence rate of partial necrosis in incision corner of group A was significantly lower than that of group B(0. 0% vs. 23. 1%,χ2 =4. 118,P<0. 05). There was no significant difference in excellent and good rate of hip functional recovery between group A(93. 8%) and group B(76. 9%) (χ2 =1. 708,P >0. 05). Conclusion Posterior approach can fully expose the field of operation with good reduction effect,provide possible for anatomical reduction of ankle mortise,good long-term efficacy can be obtained through stable fixation and postopera-tive early hip functional rehabilitation training,can be used as great reference,but need to grasp the indications.