Nonunion, malunion, and infection are complications encountered when treating fractures of the distal tibia extending into the joint surface. There is rank order of severity of those complications extending from a varus collapse of the medial column of the distal tibia with a reduced joint surface to an infected nonunion with destruction of the joint surface, segmental bone loss, and damaged soft tissue envelope. Malunion and malposition of nonunion of the distal tibia have a combination of angular deformity, translation, rotational malalignment, and shortening. These deformities require correction in the reconstruction and there are multiple technique pathways to achieving a successful reconstruction.