Objective To analyze prognostic relative factors in treatment by evaluating the surgical results of tibial pilon fracture retrospectively. Methods 32 cases with unilateral tibial pilon fracture were treated operatively between January 1997 and December 1999. Among them, 16 cases were found with unsatisfied results due to incisional complications, degenerative changes and stiffness of the ankle joint. Of 16 cases, there were 13 males and 3 females. The average age was 36.5 years (range, 25 to 55 years). The mechanisms of injury were fall in 7 cases, traffic accident in 5 cases, crash in 3 cases and other cause in 1 case. 6 cases with open fracture were treated in emergency. However, 10 cases with closed fracture were operated with an average interval of 8.1 days from injury to surgery(range, 2 to 25 days). According to the Ruedi-Allgower classification, there were type Ⅱ fracture in 7 cases and type Ⅲ fracture in 9 cases. Furthermore, there were 14 cases associated with fibular fracture. During operation, 7 cases were treated with open reduction and internal fixation with plates and screws, and 9 cases were treated with open reduced minimally and external fixation with a cast. Results The average period of follow-up was 24 months (range, 12 to 36 months). According to Mazurs criterion, the result of the treatment was evaluated as fair in 6 cases, 4 cases of which were type Ⅱ fracture, and 2 cases type Ⅲ fracture; poor in 10 cases, 3 cases of which were type Ⅱ fracture, and 7 cases type Ⅲ fracture. Complications included wound dehiscence in 1 case; infection in 4 cases, 2 of which with open fracture were superficial infection, and 2 cases with closed fracture were deep infection; posttraumatic arthritis of the ankle joint in 9 cases; and severe varus deformity in 2 cases.11 cases suffered from ankle stiffness. Conclusion Discouraged results of pilon fractures are significantly related to fracture type, reduction status and time of operation, reduction and fixation of fibular fracture, and bone grafting.