Pilon fractures are articular fractures of the distal tibia which involve the weight bearing part of the ankle joint. Assessment of the fracture is carried out with computed tomography and evaluation of the skin and soft tissue damage. In joint-preserving surgical reconstruction, treatment of the soft tissue damage has priority. The surgical approaches are preferably local and when necessary multiple (up to three) and performed simultaneously but the localization also depends on the trauma-induced damage. The surgical strategy includes joint distraction, sequential joint reconstruction and joint axis correction as well as early non-weight bearing joint mobilization.