Background: To explore the clinical effects of internal fixation on ankle fractures combined with tibiofibular syndesmosis injury under the guidance of three-column theory.Methods: Clinical data of 54 patients with ankle fractures combined with tibiofibular syndesmosis injury,who were treated from June 2008 to May 2014,were retrospectively analyzed in this study.According to the characteristics of pathological anatomy and mechanisms of injury,ankle joint was divided into three columns.Above three columns were involved when ankle fractures combined with tibiofibular syndesmosis separation appeared.There were lateral column fracture in 54 sites,ligament injury of middle column in 26 sites,avulsion fracture of the middle column in 28 sites,ligament injury of medial column in 31 sites,and medial column fracture in 13 sites.At least two columns should be fixed after the three columns were injured.Visual analogue scale pain scores were recorded at 6 months after surgery.Imaging results were evaluated using modified Baird and Jackson evaluation criteria after fracture reduction and fixation.The function of ankle joint was assessed utilizing American Orthopaedic Foot and Ankle Society ankle-hindfoot score system.Results: A total of 54 patients were followed up for 6–48 months(averagely 21 months).Healing time was 11–15 weeks(averagely 13.6 weeks).Visual analogue scale pain scores were between 0 and 6(averagely 1.4).American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 82–100,averagely 96.Radiological evaluation of therapeutic effects showed 52 excellent cases and 2 good cases with an excellent and good rate of 100%.Conclusion: Three-column classification for ankle fractures is a simple and comprehensive theory.Fixation of two columns can stabilize the tibiofibular syndesmosis after three columns were injured.