Objective To explore the application effect of microsurgical technique plus combined external fixator in the

treatment of distal tibia-fibula fracture with severe soft tissue injury. Methods A total of 84 patients with distal tibia-fibula

fracture with severe soft tissue injury from January 2021 to June 2022 were selected and divided into two groups according to

different treatment methods：41 patients treated with elastic intramedullary nail were included in the control group， and 43

patients treated with microsurgical technique combined with external fixators were included in the observation group. The

operation related situation， postoperative efficacy， postoperative complications， X-ray callus score， serum indexes （BMP-

2， VEGF， TGF-β）， ankle function （AOFAS） score， Molander ankle fracture scoring system （OMAS） score were compared

between the two groups. Results The time of preoperative preparation， operation， hospitalization， complete weight

bearing， wound healing and fracture healing in the observation group were shorter than those in the control group， and the

times of wound dressing changes were less than those in the control group （P<0.05）. The X-ray callus score of the observationgroup was higher than that of the control group at 1 and 3 months after surgery （P<0.05）

. The levels of serum BMP-2， VEGF and TGF-β in the observation group were higher than those in the control group at 1 month and 3 months after surgery （P<0.05）. Three months after operation， the good and excellent rate of operation， AOFAS and OMAS scores in observation group were higher than those in control group， and the incidence of postoperative complications was lower than that in the control group （P<0.05）. Conclusion Microsurgical technique plus combined external fixator in the treatment of distal tibia-fibula fracture with severe soft tissue injury can effectively fix the fracture， better protect and promote soft tissue repair， promote fracture healing and early limb functional recovery， and reduce the risk of complications.

Tibia-fibula fracture, Soft tissue injury, Microsurgical techniques, Combined external fixator, X-ray

callus score, Ankle joint function