: There is an increasing trend of ankle fractures in young as well as elderly patients recently. This study aimed to compare the advantages and disadvantages of tension band wiring with screw fixation for medial malleolar fractures. : All the cases of suspected ankle fractures were taken up for the study. Then the patient’s radiographs were taken, anteroposterior and lateral views of the ankle joints. CT scan is taken if it was indicated. A Total of n=30 cases were studied in this study. They were allotted into two groups of n=15 each. One group was treated with tension band wiring and the second group was treated with screw fixation. : Cases managed by tension band wiring (TBW), n=12 (80%) cases had a range of motion of the ankle within 10° of the uninjured ankle and n=2 (13.3%) patients were having motion within 15° of the uninjured ankle. The rest n=1 (6.66%) patients had motion within 20° of the uninjured ankle. Patients managed with screw fixation, n=10 (66.6%) patients had a range of motion of the ankle within 10° of the uninjured ankle and n=3 (20%) patients were having motion within 15° of the uninjured ankle. The rest n=2 (13.3%) patients had motion within 20° of the uninjured ankle.: Isolated medial malleolar fractures had a better outcome compared to the bimalleolar fractures. As far as the choice of treatment tension band wiring appears to be more desirable than screw fixation because it produces Excellent functional outcomes with minimal complications.

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