Background: Medial malleolar fractures are common ankle injuries that can be managed using different surgical techniques. This research purposed to evaluate the short-term effects of percutaneous cancellous screw fixation against open reduction and internal fixation in the treatment of minimally displaced medial malleolar fractures. Methods: This study included a random sample of 20 patients who have minimally displaced medial malleolar fracture, fulfilled the inclusion criteria and completed 6 months follow up period at the Orthopedic Department of Benha University Hospitals and Mahalla General Hospital. Patients were split into 2 equal groups: Group I (Percutaneous group): included 10 patients who were treated with Closed Percutaneous cancellous screw Fixation. Group II (open group): comprised of 10 patients treated with open reduction and internal fixation. Results: A substantially critical change was present between both groups according to Operative Time which was 36.33 ± 5.16 min. in Percutaneous group and 54.00 ± 12.28 min. Conclusions: The percutaneous technique for fixation of closed fractures of the medial malleolus is adequate and provided satisfactory final outcome but the open reduction and internal fixation allows removal of the trapped periosteal flap, direct inspection of the joint and the fracture so, it is better to use open reduction technique in all cases but in cases with bad soft tissue condition percutaneous technique could be used with acceptable results.