Objective To investigate the clinical effect of C-arm X-ray machine assisted minimally invasive treatment of 24 cases of Rüedi-AllgöwerⅡ, Ⅲ closed Pilon fractures withL-shaped anatomical locking plates.Methods C-arm X-ray machine was used to fluoroscope the fractures.Patients whose incision of tissuewas limited and fracture reduction was satisfactory were selected. L-shaped anatomical locking plateswere fixed well in these patients between January 2013 and December 2018.Results All the cases were followed up for 6 to 24 months, with anaverage of(15±3.25) months. The fracture healing of the patients was good. There were no such complications as wound infection, vascular injury or ankle stiffness. Only one patient developed traumatic arthritis, which returned to normalafter a year of rehabilitation. According to Mazur ankle function score and fracture reduction and healing degree evaluation, 16 patients were rated as excellent, 5 as good, and 3 as fair. The rate of excellent and good effect was 87.5%.Conclusions The curative effect of minimally invasive treatment of Rüedi-Allgöwer Ⅱ, Ⅲclosed Pilon fracture with L-shaped anatomical locking plates assisted by C-arm X-ray machine is satisfactory.