Twenty-one patients with tibial pilon fractures were treated with ring fixators and arthroscopy. There were 2 Type I, 14 Type II, and 5 Type III fractures using the Ruedi classification. In Ruedi Types I and II fractures, ring fixators were applied to the tibia and foot, and closed reduction was performed, monitoring the quality of the reduction with an image intensifier. When the quality of the reduction was questionable, arthroscopy was used, and if necessary, the reduction was readjusted. Olive wires were used to achieve reduction and fixation. In all Ruedi Type III fractures and 4 Ruedi Type II injuries, a limited open reduction was performed instead of arthroscopy. Approximately 8 weeks after the operation, the foot mounting was removed. The ring fixators were removed between 16 and 28 weeks. Bony union was achieved in all but 1. At an average followup of 37 months, there were 15 good, 4 fair, and 2 poor results. There were 8 cases of pin tract infection, and 1 patient had loss of reduction. There were no cases of deep wound infection. It was concluded that ring fixator and adjunctive arthroscopy is safe and effective in the management of tibial pilon fractures.