Aim of the Work: to compare results of treatment with percutaneous method and ORIF by lag compression screw method in medial malleolar fracture in adults. Patients and Methods: This prospective comparative study included 20 patients with medial malleolar fracture, they were divided into two groups; group A was reduced by closed method and group B was treated by ORIF by lag compression screw. They were recruited and assessed for eligibility from orthopaedic surgery department at El-Salam hospital and Benha University hospital. Results: Regarding the demographic data in all patients, the mean age of the recruited patients was 33.30 years old and that 65% of patients were males and 35% were females. Regarding the side and associated fractures in all patients, our results indicated equal distribution of fractures (50% right and 50% left side). The majority of patients (45%) have isolated medial malleolar fractures, however, 35% of patients have associated lateral malleolus fracture, 15% have associated trimalleolar fracture and 5% have associated femur fracture. Conclusion: Both closed reduction percutaneous fixation and open reduction internal fixation resulted in acceptable radiographic outcomes and low complication rates for the treatment of medial malleolar fractures. The advantages of the percutaneous fixation are the avoidance of potentially excessive soft tissue dissection associated with the open approach; however, it is associated with higher rates of delayed union due to the limited visualization. The advantages of ORIF method include being highly satisfactory in most patients and good functional outcome, however, it is associated with skin necrosis, infections, and wound healing disorders