Objective To investigate the clinical effect of wrist arthroscopy combined with open reductionand internal fixation for elderly distal radius fractures complicated with triangular fibrocartilage complex injury.Methods A total of 68 elderly patients with distal radius fractures treated in the arthroscopy department of HenanLuoyang Orthopedic Hospital（Henan Orthopedic Hospital）from January 2018 to January 2020 were analyzedretrospectively. All patients were divided into two groups according to the operation method. The treatment group（n = 33）was given wrist arthroscopy combined with open reduction and internal fixation；The control group（n = 35）was treated with open reduction and internal fixation alone. The intraoperative indexes，wrist range of motion，gripstrength and DASH score before and 12 months after operation were compared between the two groups. Theimproved Mcbridei wrist function score and complications were followed up 12 months after operation. Results Significant differences in intraoperative indexes，wrist range of motion，grip strength and DASH score between thetwo groups before and 12 months after operation were found（P < 0.05）；The improvement degree of the above wristjoint indexes in the treatment group was better than that in the control group（P < 0.05）；12 months after operation，the excellent and good rate in the treatment group was 90.9%，which was higher than 70.4% in the control group（χ2 = 4.169，P < 0.05）. During the follow⁃up，the incidence of arthritis and uneven articular surface in the treat⁃ment group was lower than that in the control group（χ2 = 5.184，P < 0.05）. Conclusion Wrist arthroscopy couldrealize anatomical reduction and fixation of the fracture end under direct vision in elderly distal radius fractures，diagnose and repair the complicated injury of triangular fibrocartilage complex and ligament，effectively reduce theoccurrence of wrist pain and complications and the clinical effect is accurate and reliable.