The incidence of tibial fractures accounts for approximately 10.5% of long bone fractures and is high among long bone fractures, the most common being distal tibial fractures. Due to its special anatomy and proximity to the ankle joint surface, the distal tibia is prone to injury to the ankle joint if a fracture occurs, and there is also soft tissue injury. The use of external fixation and intramedullary nail fixation can easily lead to the occurrence of infection or ankle joint dysfunction. 1. Data and methods 1. 1 General data There were 62 cases in this group, 48 male and 14 female; age ranged from 17 to 65 years, mean age 37.5 years. There were 39 cases on the right side and 23 cases on the left side. Causes of injury: 24 cases of heavy object injury, 21 cases of traffic injury, 17 cases of fall from height injury. The fractures were classified according to AO, 37 cases were type A, 20 cases were type B, and 5 cases were type C. There were 20 open fractures and 42 closed fractures. 35 cases were operated in emergency and 27 cases were operated 5-10 days after injury. The time from injury to surgery was 6 h to 10 d. 1.2 Treatment 121 Preoperative preparation. After admission, the injured limb was fixed by manual repositioning, heel node traction or plaster rest, prophylactic application of antibiotics, and application of dehydrating and decongesting drugs such as β hepatosaponin sodium, 20% mannitol, and safflower injection. For 35 patients with open wounds but relatively clean wounds and closed fractures with less severe local soft and soft tissue swelling, emergency surgery was performed; the remaining 27 patients with severe wound contamination or significant local soft tissue swelling were fixed with heel node traction or plaster rest after repositioning, local ice was applied, and surgery was performed in 5-10 d. after the inflammation or local swelling had subsided. 1.2.2 Surgical method. Continuous epidural anesthesia was used, with supine position and tourniquet inflation to stop bleeding. For those with open wounds, debridement was performed first. The lateral tibial incision is made, and for patients with fragmentary fractures resulting in ankle joint surface injury, the ankle capsule needs to be incised to remove the hematoma, and those with fibular fractures are firstly repaired. With ankle joint surface fractures or severe comminuted fractures, temporary fixation of the joint surface is first performed using tension screws or kerf pins. A distal tibial anatomic plate is placed on the anterolateral side of the tibia. The distal end is fixed with cancellous bone screws and the proximal end is fixed with cortical bone screws. For severe comminuted fractures of the distal tibia, additional screws can be added to the plate. The fracture is fluoroscopically visualized using a C-arm x-ray machine for good fracture repositioning. For severe comminuted fractures with significant bone loss, autogenous bone or artificial bone material may be used. After the fixation is completed, the temporary fixation pins and screws are removed, and in case of large wound tension, a decompression incision is made on the outside of the incision, and the incision is cleaned and placed with a drainage tube, and then the incision is sutured and wrapped with a thick cotton pad with appropriate pressure. 1.2.3 Postoperative treatment. The affected limb was elevated after surgery, and the terminal blood flow was closely observed. 24-48 h after surgery, the drainage tube was removed depending on the drainage bag drainage, the wound was routinely disinfected and changed, and antibiotics were applied for 5-7 d. For patients with obvious postoperative swelling, dehydration treatment was carried out with β heptaerythroside sodium and 20% mannitol. Patients were asked to perform passive activities of plantar flexion and dorsiflexion of the toes and ankle joint on the next day after surgery, and were asked to perform functional recovery exercises of the knee and ankle joints in bed 5-7 d after surgery, and were reviewed regularly, and weight-bearing was performed when a certain amount of bone scab was formed at the fracture end, and the internal fixation was removed about 1 year after surgery according to the fracture healing. 1.2.4 Evaluation criteria. The Takakura ankle joint score was used as the efficacy evaluation standard, excellent: no painful symptoms in the affected joint, no restriction in walking distance, going up and down stairs, sitting on the ground with both legs crossed, consistent with the function of the healthy side joint; good; slight soreness of the joint, obvious swelling of the joint after walking, unable to participate in physical activities, joint mobility is 50% to 75% of the healthy side; acceptable; obvious soreness of the joint, obvious swelling of the joint after walking. After walking, joint swelling is obvious, walking is difficult, joint mobility is 25% to 50% of the healthy side, dorsal extension is 6° to 10°, plantarflexion is 21° to 35°; poor; the joint is obviously swollen and has severe pain, joint ankylosis, walking is not possible. All of the patients had fracture healing, good functional recovery of the ankle joint, and no plate or screw fracture or withdrawal. 60 cases had stage I wound healing, and 2 cases had superficial wound infection, which healed after intensive wound dressing. There were no complications such as infection spreading, plate exposure, no osteomyelitis, no ankle symptoms and functional evaluation results: 46 cases were excellent, 12 cases were good, 3 cases were acceptable and 1 case was poor. The ankle joint is the largest weight-bearing joint in the human body, and it needs to bear the weight of the whole body when standing, and the load can reach about 5 times of the body weight when walking. The dorsiflexion and plantarflexion of the ankle joint can realize the walking and jumping activities in daily life. The shape of the tibia changes from trigonous to quadrilateral, the soft tissue is weak, and the epiphysis is mainly composed of cancellous bone Due to the fracture of the distal tibia, which often leads to Pilon fracture that affects the ankle joint due to its proximity to the ankle joint, the treatment is more difficult due to its traumatic anatomical peculiarities. Due to its special anatomy and proximity to the ankle joint surface, the distal tibia is prone to injury to the ankle joint if a fracture occurs, and there is also soft tissue injury. The use of external fixation and intramedullary nail fixation may lead to infection or ankle joint dysfunction. The use of anatomic plates not only reduces the incidence of infection, but also provides good fixation of the small bone distal to the fracture. At the same time, the lower end of the anatomical tibial plate has been pre-shaped, and the distal part of the plate is lobed and enlarged, with two screw holes arranged transversely, which can facilitate the passage of the kerf pins, and at the same time, it is compatible with the surface morphology of the inner and outer tibia, so there is no need for repeated intraoperative shaping, which not only can avoid the loss of plate strength due to multiple bending of the plate, but also can reduce the operation time. For comminuted fractures, the anatomical plate can also play the role of a mold to facilitate the revision of the fracture. In 62 patients with distal tibial fractures treated with internal fixation of distal tibial anatomical plate, 60 patients recovered normal function after surgery, no deformity healing occurred, and no ankle pain during walking. 2 patients had severe ankle joint ankylosis or severe adhesions around the ankle joint due to severe comminuted fractures or insufficient postoperative rehabilitation exercises, and the mobility of the ankle joint was 20% of that of the healthy side. The distal tibial anatomical plate was pre-processed and shaped, and basically no further shaping was needed to avoid the reduction of plate strength caused by bending injury, and it conformed to the surface morphology of the medial and lateral tibia, and the fracture could be anatomically and functionally repositioned according to its morphology, effectively reducing the injury caused by large stripping of the periosteal area, reducing the chance of bleeding and infection, shortening the operation time, and at the same time achieving a good fracture repositioning effect The fracture can be repositioned with good results. The current treatment methods of distal tibial fracture, distal tibial anatomical plate internal fixation is the ideal choice among distal tibial fracture treatment methods, and it is worth to carry out a step in clinical promotion.