SummarySmall-tensioned-wire external fixation techniques can achieve excellent results in the treatment of distal tibial pilon fractures. Such techniques are especially useful in those injuries with extensive articular comminution and diametaphyseal shaft extension and those injuries with significant soft tissue compromise. An immediate ligamentotaxis reduction, followed by a traction computed tomography scan, is invaluable in the preoperative treatment of these injuries. Limited incisions may aid in the reduction of these injuries. The fixation is accomplished using small tensioned olive wires and, in some fracture patterns, cannulated screws. The technique is described herein with various traction techniques, including calcaneal traction, two-pin temporary external fixation, and ligamentotaxis through an Ilizarov-type frame.