Background: Medial malleolus fractures (MMF) are prevalent among middle-aged and elderly populations. Percutaneous screw fixation (PSF) has emerged as a contemporary surgical technique for the management of these fractures. Material and methods: This prospective descriptive study was conducted at Erbil Teaching Hospital, West Erbil Emergency Hospital, and East Erbil Emergency Hospital in Erbil from April 1st to June 30th. The cohort comprised 32 adult patients diagnosed with MMF, who underwent PSF. Postoperative radiographs were obtained at 6 weeks to assess fracture union, with additional follow-ups at 12 weeks and as necessary thereafter. Results: The mean age of the patients was 43.3 years, with a male predominance of 59.37%. The predominant cause of injury was falls from heights (53.1%). The fracture union rate was 100%, with a mean time to union of 9 weeks. Postoperative complications included tenderness due to hardware irritation (15.62%), malunion (6.25%), superficial infections (6.25%), and painful bursa (6.25%). An excellent functional rating was observed in 65.62% of patients postoperatively. Conclusions: Percutaneous screw fixation of MMF demonstrates favorable outcomes in terms of union rates and soft tissue condition, effectively mitigating the impact of soft tissue interposition on fracture healing.