PURPOSE : To evaluate the usefulness of the treatment method of limited open reduction for the articular surface and combined. external fixation in a tibial pilon fracture. MATERIALS AND METHODS : We reviewed 15 cases of pilon fracture treated by the combined internal and external fixation method. The fracture was classified by Ruedi and Allgower's classification: 3 cases of type I , 7 cases of type II and 5 cases of type III. The result was analyzed by Ovadia and Beals' radiologic, subjective and objective criteria of assessment. RESULTS : The results were 12 good and 3 fair in the radiologic evaluation; 1 excellent, 9 good, 3 fair and 2 poor in the objective evaluation; and 5 good, 8 fair, 2 poor in the subjective evaluation. The mean duration of the bony union was 6.5 months (5-11 months). The most common complication was the limitation of the ankle joint. Intra-articular arthroscopic adhesiolysis and extra-articular soft tissue release were helpful to increase the range of motion of the ankle joint. CONCLUSION : This technique provides a satisfactory result in the anatomical reduction of the articular fracture, in the management of the soft tissue problem particularly in open fracture, and permits early motion of the ankle joint in the pilon fracture.