Fifty seven patients with displaced isolated medial malleolar fractures were randomized to receive closed reduction and percutaneous fixation (n=28) or open reduction and internal fixation (n=29), both using two partially threaded 4-mm cannulated screws. The primary outcomes were time to radiographic union and complication incidence. Secondary outcomes included FAAM-ADL, FAAM-Sports, AOFAS ankle-hindfoot score, and pain (VAS). Outcomes were assessed at scheduled visits to 12 months, with final follow-up 12–24 months (mean ≈17 months). Overall, the results revealed no between-group differences in FAAM, AOFAS, or VAS at final follow-up, while percutaneous fixation achieved slightly faster union and fewer superficial infections; operative time was also shorter with the percutaneous approach. These findings suggest percutaneous fixation is a reasonable alternative to open surgery for displaced isolated medial malleolar fractures.