Introduction: Fracture dislocations of the ankle are rare injuries with often poor outcomes due to posttraumatic arthritis and instability of the ankle. A concomitant fracture of the posterior malleolus occurs in 7–44% of all ankle fractures. Aim of the study: To study the outcomes in operated cases of posterior malleolus fractures fixed using percutaneous anteroposterior (AP) screws vs posterior buttress plating and to study which is advantageous. Materials and methods: Our study was conducted between December 2013 and December 2015. All operated cases of posterior malleolus fractures in trimalleolar fracture dislocations of the ankle joint were included. Polytrauma cases and open injuries were excluded. Among 28 cases, 24 cases were available for final follow-up. The average age was 47.2 years, and road traffic accident was the predominant cause in 80% of the cases. In 9 cases, buttress plating, and in 15 cases, percutaneous AP screws were used as decided by senior surgeon. All cases were followed up at periodic intervals. Mean follow-up is 28.5 months. Results: Average union time is 14.2 weeks. Ankle fracture scoring system designed by Phillips et al. was used. The outcome is the sum of the clinical score (follow-up), the anatomical score (postoperative), and arthritis score (follow-up). A minimum score is 0, and the maximum score is 150. In posterior plating group, the average score was 128 out of 150. In AP screws group, the average score was 114 out of 150. Improper reduction and articular step were noticed in three cases and developed ankle arthritis in subsequent radiographs. There were no infections in our series. Conclusion: Posterior plating gave better results due to stable anatomical reduction and by early physiotherapy, while AP screws group had relatively moderate outcome due to articular step off and late arthritic changes.