Fractures involving the weight bearing surface of the lower part of the tibia are referred to as tibial plafond or pilon fractures. These are high energy injuries that usually occur from falls from height or automobile accidents in which the foot is driven up into the bone of the lower leg. Associated injuries to the pelvis and lower spine are commonly present. These are difficult fractures to treat and should only be definitively repaired by an experienced fracture surgeon. Initial treatment consists of re-aligning the bones of the lower tibia and application of an external fixation device to maintain the alignment of the bones. Timing of the definitive surgery is variable but is related to the condition of the soft tissues as the most common complications are related to operating too early, before the skin and soft tissue has had enough time to “cool off”. Repair is performed using plates and screws to hold the bone aligned. Most patients will stay in the hospital for about 5 days after the definitive surgery. All patients remain non-weight bearing for a period of at least 8 weeks, although therapy to regain ankle motion and pool therapy are useful. Recovery is slow and progresses over the course of 12-24 months. Stiffness and subsequent ankle arthritis are common even after anatomic reconstruction of the joint and stiffness persists in more than 50% of patients.