Background:Pilon fractures remain one of the most substantial therapeutic challenges that confront the trauma surgeon. Numerous features are responsible for this. The use of external fixation, instead of fixation with a plate,and use of ilizarov decreases the prevalence of early complications. Aim of work:To evaluate the efficacy of using ilizarov external fixator in treating pilon fractures regarding fracture union, clinical outcome and rate of complications. Patients and methods:Twenty four pilon fracture patients were incorporated in a prospective study.The fractures have been treated with the Ilizarov apparatus. 3 or 4 rings were used according to the fracture type. Pre- and post-operatively conventional radiographs, postoperative pain assessment and complications were evaluated. Pain assessment after operation, radiology, definitive outcomes and complications post-operation were performed, the follow up were done after 6 months.Clinical outcomes were evaluated according to the ankle-hindfoot score devised by the American Orthopaedic Foot and Ankle Society (AOFAS). Results:No patient developed compartment syndrome or deep venous thrombosis. Pin infections were frequent, but they were mostly superficial and were treated with antibiotics and local antiseptics.2 cases of malunion occurred, one of them required ankle fusion. Another patient had a severe residual deformity. One case experienced delayed union and was treated with dynamisation of ilizarov frame, otherwise all fractures united and the fixator was removed after a mean of 20 weeks (range 12–28). The clinical outcome according to AOFAS score was excellent in 12 patients, good in 6, fair in 4 and poor in 2. Conclusion: The study demonstrated that it is possible to achieve a satisfactory outcome, in pilon fractures, with the Ilizarov technique allowing early definitive treatment. The fractures were treated immediately after the injury, regardless of soft-tissue damage. This was done with a similar low complication rate in both the extra- articular and the intra-articular fractures. Patient compliance was good. The residual deformities were within the range in which the risk of developing post- traumatic osteoarthritis can be expected to be low.