The tibial Pilon fracture is difficult to manage because high energy axial compression and rotational forces which make severe injuries to the ankle joint, which result in impaction, severe comminution, metaphyseal disruption and soft tissue trauma. Though there are variable methods of treatment including manipulation and cast, calcaneal traction and cast, external fixation, pin and plaster, limited open reduction and external fixation, open reduction and internal fixation and arthrodesis, most of authors reported better result after a surgical treatment than that of conservative treatment. While there is no doubt that the treatment of ankle joint injuries is much improved today, complications are still very common for many reasons. We have reviewed the 19 cases of the tibial plafond fractures on 18 patients which were treated at orthopedic department, Walles Memorial Baptist Hospital, from March 1991 to February 1995. The results were as follows . 1. There were so much combined injuries that physician must evaluate other injury such as spinal compression fracture. 2. The most frequent type of pilon fracture was type 3, the 2nd was type 5 by Ovadia and Beals classification. 3. Regardless of the treatment method, type 1 and 2 were excellent subjective result by Ovadia and Beals subjective evaluation classificatioin, but in case of type 3, 4 we could get a good and excellent result by anatomical open reduction and internal fixation. 4. We could reduce complications of the postoperative wound infection and skin necrosis by posteromedial and posterolateral approach after skeletal traction and manual reduction for more than one week.