This study reviewed operative treatment of Maisonneuve fracture of the fibula in 26 patients. Operative treatment consisted of restoration of the fibular length, repair of the lateral and medial ankle ligamentous structures, and placement of one or two suprasyndesmotic screws. After average follow-up of 6.4 years, the clinical results were satisfactory in 23 (88.4%) patients. Operative treatment is the treatment of choice for Maisonneuve fractures, and a satisfactory outcome may be anticipated after appropriate management of any associated bony and syndesmotic injuries.