Thirty-eight consecutive pilon fractures were reviewed retrospectively to compare the radiographic and clinical results with the original injuries based on three different treatment options: external fixation only, external fixation with limited internal fixation, and internal fixation only. Dates of injury were from February 1985 to February 1989. Treatment method was the surgeon's preference. The mean follow-up time was 28 months. Results were tabulated by clinical and radiographic scores. In general, simple fracture types had good results; complex ones did less well. In this study, fracture severity appeared to be the key variable in outcome.