The authors retrospectively reviewed 13 pilon fractures in 12 patients treated with a diaphyseal-epiphyseal technique of Ilizarov external fixation. Clinical followup averaged 16 months (range, 12-25 months). Eighty-four percent of the fractures had healed within 16 weeks after surgery. Average range of motion of the ankle was 12 degrees dorsiflexion and 25 degrees plantar flexion. One delayed union was treated with bone grafting and eventually healed; 1 nonunion was treated with ankle arthrodesis. Most patients (91%) experienced mild or no pain. There were no deep infections. This technique is an effective treatment option for tibial pilon fractures.