Abstract: Objective To design a modified minimally invasive anteromedial approach (MMIAA) for medial malleolar fractures and to evaluate the clinical outcomes of treating medial malleolar fractures with hollow compression screws via MMIAA. 
Methods Thirty-nine patients who met the inclusion criteria were selected for the treatment of medial malleolar fractures using MMIAA.Patients were followed up and evaluated by visual analogue painscale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score and Ankle Function score (Kofoed scale). 
Results All 39 patients were followed up for 13-20 months, with a mean of (16.3 ± 2.0) months. All patients achieved bony healing with a mean of (3.0±0.79) months. No incision-related complications were recorded. The mean time from injury to surgery was (3.2±1.4) d, the mean duration of operation was (55.9±9.8) min and the mean length of the surgical incision was (3.7±0.5) cm. According to 12-month follow-up, the mean AOFAS score was (95.1±7.4) points,which were excellent in 31 cases （79.5%） and good in 8 cases （20.5%), with an excellent and good rate of 100%. According to the Kofoed ankle function score with a  mean of (94.4±8.6) points, 32 cases were assessed as excellent， 6 cases as good and 1 case as fair, with an excellent and good rate of 97.4%. 
Conclusion The MMIAA allows a direct visual repositioning of the articular surface and cortex in a minimally invasive manner, and minimizes soft tissue damage as well. MMIAA is an ideal option for most of medial malleolar fractures especially for Herscovici type B and type C.

Key words: ankle fractures, minimally invasive surgical procedures, hollow compression screw