SummaryThe early treatment of pilon fractures using joint spanning devices for resuscitation is discussed. Compartment syndromes, vascular injury, and injuries that may need amputation are discussed. Reduction technique for Type A and C1 and C2 pilon fractures using tibial frames is illustrated. Treatment for C3 pilon fractures with bridging frames is also illustrated. Management of fibular fracture patterns and joint comminution are illustrated. Reconstruction techniques of bone grafting, acute shortening, intercalary bone transport, and lengthening are illustrated.