SummaryThe technical strategies to treat fractures of the tibia with Ilizarov fixators are described. An Ilizarov fixator can be applied as a neutralization device after open or pericutaneous reduction, as an active reduction device using universal hinge mechanisms between fixation blocks, or as an external scaffold which incorporates distraction/compression and the placement of pins and wires to apply force through pivot points and levers. Periarticular fracture patterns are classified into five types: Type 1, intact metaphysis; Type 2, simple sagittal or coronal fractures; Type 3, moderate large fragment joint fractures; Type 4, comminution of the joint; and Type 5, severe crushing with bone loss. The concept of fixation blocks and orthogonal placement of pins and wires is introduced.