Objective To compare the efficacies of nickel-titanium (NiTi) shape memory arch nail and distal tibiofibular screw in the treatment of Maisonneuve fracture (MFF). Methods The clinical data of 33 patients with MFF treated at our hospital from Jan. 2019 to Dec. 2021 were retrospectively collected. According to the treatment methods, the patients were divided into 2 groups: shape memory arch nail treatment group (arch nail group, 13 cases) and distal tibiofibular screw treatment group (screw group, 20 cases). The surgical time and intraoperative blood loss were compared between the 2 groups, and the surgical outcomes were evaluated according to the American Association of Orthopaedic Foot and Ankle Surgeons (AOFAS) scoring criteria at the last follow-up. Results There were no significant differences in the surgical time (［118.46±19.55］ min vs ［113.50±17.97］ min) or intraoperative blood loss (［90.77±53.85］ mL vs［94.50±46.53］ mL) between the 2 groups (both P＞0.05). Both groups achieved primary wound healing after surgery without local complications such as skin necrosis or wound infection. All patients in both groups were followed up for 6 to 24 months, with an average follow-up duration of (14.70±5.20) months. At the last follow-up, there were no significant differences in the overall evaluation score of ankle joint function or ankle joint symptom evaluation score of AOFAS between the 2 groups (both P＞0.05). Conclusion Both NiTi shape memory arch nail and distal tibiofibular screw are effective in treating combined injuries of the distal tibiofibular joint in MFF. In addition, NiTi shape memory arch nail not only can preserve the physiological movement of the ankle joint and distal tibiofibular joint, but also requires no routine removal before weight-bearing. Therefore, it is a treatment method worthy of promotion.