Objective: To compare the outcome of patients with supination external rotation-4 ankle fracture in two different surgical methods. Methods: Sixty-nine patients with SER-4 ankle fracture in Third Affiliated Hospital of Anhui Medical University from Aug 2016 to Sep 2017 were selected and categorized into two groups: 38 patients deltoid ligament repair are group A, and other 31 patients with syndesmotic fixation are group B. Internal fixation operation time, fracture healing time, AOFAS Ankle Hind-foot Scale, blood loss, range of motion of ankle joint were retrospectively analysed. Results: There were no significant differences between the two groups in blood loss, the operation time and fracture healing time (P>0.05). Range of motion after operation and AOFAS Ankle Hindfoot Scale in group A is better than group B (P<0.05). All patients in the syndesmotic fixation group underwent a subsequent procedure for removal of the syndesmotic implant. There was significant difference between two group in the frequency of complications (P<0.05). Conclusion: Repairing the deltoid ligament can firmly restore ankle stability in SER-4 ankle fracture, and is superior to syndesmotic fixation in functional recovery, and can avoid inherits surgical risks that occur during a subsequent operation for removal of the syndesmotic implant.