SummaryThe anatomy of the proximal metaphysis, shaft, and distal metaphysis of the tibia, and how it determines the safe pin and wire pathways when fixating the tibia using Ilizarov fixators are described. Wire placement in the foot is described for bridging frame applications for pilon fractures. The safe wire positions adjacent to the knee and ankle joint are described. The lateral centered view is used to safely place wires adjacent to the joint capsule. Unsafe wire and pin positions are illustrated and techniques to avoid poor wire placement are described.