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Objective: To study the therapeutic efficacy of manipulative reduction and percutaneous pin fixation for the treatment of severely displaced distal tibial fractures in children., Methods: From May 2009 to December 2012,56 children with severely displaced distal tibial fractures were analyzed, who had been treated with manipulative reduction and percutaneous pin fixation. Preoperative fractures were confirmed as severely displaced fractures by X-ray apparatus. There were 33 boys and 23 girls,ranging in age from 3 to 14 years, with an average of 10.1 years. All the fractures were closed without vascular or nerve injuries. According to the bone fracture type, under C-arm fluoroscopy, functional reduction was achieved by manipulative reduction. The fractures were fixed with percutaneous pins. Postoperative X-ray confirmed the functional reduction. Follow-up indexes were recorded: intra-operative and postoperative complications,postoperative radiographic examination, lower extremity length and range of ankle motion. Ankle score system of Teeny was used to evaluate ankle function., Results: All the patients were followed up, and the duration ranged from 3 to 46 months, with an average duration of 19.4 months. According to the Teeny score standard, 35 patients got an excellent result, 7 good and 3 fair. Pin track reaction was found in 4 cases. The X-ray showed all the fractures healed without shortening deformity or epiphyseal arrest at early stage. All the patients could participate in the normal physical activities, having a normal range of motion and excellent strength of the ankle joint., Conclusion: The method of manipulative reduction and percutaneous pin fixation is a safe and convenient treatment for severely displaced distal tibial fractures in children. It has several advantages as follow: micro-trauma, tiny tissue damage, firm fixation, and the patients can exercise the function of ankle early, suggesting that it is an effective treatment method.