SummaryTreatment of complex fractures of the distal tibia has improved dramatically over the past 10 to 12 years.4–7,9,10Better understanding of the soft tissue injury, indirect reduction methods, low profile, and custom implants have increased the surgeon’s ability to achieve better results.5,7,9,10To accomplish this goal, the surgeon must strive for anatomic reconstruction and stable fixation without compromising the soft tissue envelope. This allows for early rehabilitation during the healing process. The use of external fixation has become an essential component of treatment of these injuries.4,5,7,9The external fixator can be part of staged treatment, an intraoperative reduction tool, or adjuvant to definitive fixation. The “hybrid” type of external fixator described uses wires in the talus and calcaneus combined with half pins in the tibia. Ideally, external fixation allows for improved indirect reduction capabilities and excellent stability with a low risk of pin infection and loosening. This configuration gives the surgeon an increased ability to achieve stable, anatomic reduction of these difficult injuries.