Fractures of the tibial pilons are difficult to manage because of their severity. They are the products of high-energy compression force and too frequently result in comminution and impaction of the weight bearing surface of the distal tibia. Treatment modalities are conservative treatment such as closed reduction and cast immobilization that have the risk of joint incongruency and future osteoarthritic complications, and open reduction and internal fixation that have brought good anatomical joint surface but may have many surgical problems especially of wound infection and osteomyelitis. We have reviewed 65 patients from January 1980 to December 1991 at the department of orthopaedics, Yonsei University Wonju College of Medicine. The results were as follows: 1. The fractures were classified into five types according to the system of Ovadia and Beals. The methods of treatment were divided into two groups; open reduction and rigid internal fixation by AO techniques, and other methods. 2. The most important variables that affected the final clinical result were the type of fracture, the method of treatment, and the quality of the reduction(P<0.05). 3. Regardless of the method of treatment, all of the eight type-I fractures had an excellent or good final clincal result, as contrasted with only 27 percent excellent or good result in the eleven patients who had a type V fracture. The final clinical results of treatment by open reduction and internal fixation, however, were generally better than those by other methods. 4. Complications were numerous and occured more commonly in ORIF groups than others groups. Superfical infections or skin necrosis were the most common complication.