PURPOSE: We evaluated the results between the methods of open reduction and internal fixation using plate and screws and the methods of closed reduction and fixation with rush pin in lateral malleolar fractures. MATERIALS AND METHODS: We analysed the 33 fractures of lateral malleolus which had been treated by open reduction and internal fixation using plate and screws or closed reduction and fixation with rush pin from January 1995 to January 2002 and had been observed over 1 year. The 33 patients were observed for the comparison of radiologic and clinical results in according to the measure of McLennan and Ungersma. RESULTS: Among the 33 cases, 15 cases were treated by open reduction and internal fixation with plate, and 18 cases were treated by closed reduction and Rush rods fixation. In according to the measure of McLennan and Ungersma, good radiologic result was 60% (9 cases) and excellent clinical result was 27% (4 cases) in plate fixation, and good radiologic result was 61% (11 in 18 cases) and excellent clinical result was 39% (7 in 18 cases) in Rush rods fixation. CONCLUSION: In ankle fractures of elderly patients who have soft tissue problems and osteoporotic bony quality, radiologic and clinical results of internal fixation of distal fibula were relatively same between fixation with plate and screws and Rush rods. Therefore, closed reduction and internal fixation with Rush rods is one of the good treatment modalities of distal fibular fracture.