External fixation has been shown to be an effective method of stabilization for tibial pilon fractures. Benefits of early external fixation include preliminary fracture reduction, maintenance of fracture length, and control of edema. These features facilitate delayed open reduction and internal fixation and allow for successful wound healing after surgery. At present, tibial pilon fractures are stabilized with placement of an external fixator in the operating room or by placement of calcaneal traction. However, expeditious application of an external fixator in the emergency department provides a superior alternative for many of these patients. We present a technique for the placement of an emergency room external fixator for the treatment of closed tibial pilon fractures. This procedure is indicated in critical (multi trauma) patients whose conditions may preclude fracture treatment in the operating room. Additional indications include delay in operative treatment in greater than 12 hours and significant soft tissue swelling requiring serial observation. Contraindications include open fractures, ipsilateral calcaneal or proximal tibial fractures, extensive soft tissue injury with contamination, and compartment syndrome. Emergency room external fixation provides a safe and effective means of stabilization for closed tibial pilon fractures.