Back Ground:Ankle joint is a close-tting complex hinge joint. The attachments of ligaments increase the complexity of inferior tibio-bular & tibio- talar joint. Ankle fractures can lead to long term morbidity with pain, arthritis & joint instability. So management of the ankle fractures are challenging for the surgeons.Materials & Methods:Acomparative study was done with 40 cases of medial malleolus fracture treated surgically at Government General Hospital, Srikakulam from June 2020 to October 2022 & studied for 6-18 months. 15 fractures were treated by tension band wire & 25 fractures by screw xation. Results: Tension Band wire gave excellent results in small & osteoporotic fractures. Screw xation gave excellent results in vertical fractures. Range of motion was better in screw xation. Radiation exposure was less in TBW but operation time is higher. There was no signicant difference in union time, Infection rate & functional outcome between both the procedures. Average time for bony union for screw xation was 10.8 weeks & 10 weeks for tension band wire. Conclusion:Both the methods can be done in malleolar fractures. TBW can be preferred in small & Osteoporotic fractures & screw xation should be preferred in vertical fractures due to selective advantages