The aim of this study is to compare two methods of internal fixations for isolated fractures of medial malleolus by partially threaded screw fixation and tension band wiring. Patients and Methods: Over the period of 2 years we grouped 20 patients of fractured medial malleolus randomly into two groups of operative treatments, group1 treated by 4mm partially threaded lag screw fixation and group 2 by tension band wiring. Modified ankle scoring system of Olerud and Molander was used to assess outcome of procedures. We use Independent sample t test for analysis and make a comparative study between the two ways of surgical treatment. Clearance from ethical committee is obtained and informed consent from all patient taken for study. Results: The mean time for radiologic bone union was 11 weeks in Group 1 patients and Group 2 patients. No patients had any sign of fixation failure or Kirschner (K) wires migration. According to the modified ankle scoring system of Olerud and Molander excellent and good results were achieved in 80 % in group1 patients and 90 % in group 2 patients (P = 0.049). Conclusions: Tension-band wiring may be better treatment option for internal fixation of medial malleolar fractures than screw fixation in small fragments avulsion fracture.