Distal tibial fractures are highly prevalent in clinical practice, mostly involving the ankle joint, and require surgical intervention. Different surgical approaches are chosen according to the fracture site, which are listed as follows: 1. Anterior approach is suitable for simple anterior ankle fractures, which can maximize the exposure of the anterior ankle and facilitate surgical operations. 2. Medial approach is suitable for simple medial ankle fractures, which can maximize the exposure of the medial ankle and facilitate surgical operations. 3. The posterior approach and the posterolateral approach are suitable for simple posterior ankle fractures, which can maximize the exposure of the posterior ankle area and facilitate the surgical operation. The most commonly used clinical approach is the anterolateral approach, which can solve multiple problems at the same time. In the surgical operation of distal tibial fractures, attention should be paid to the protection of anatomical sites such as the great saphenous vein and the small saphenous vein.