The mechanical support of the fibula accounts for 1/6 of the lower leg, plus the alignment of its lower fracture will affect the stability and functional activity of the ankle joint, therefore, it must be fixed, either by plate or by intramedullary fixation with Kristen pins, I prefer to use the latter because of its small incision, less tissue stripping and less surgical creation, plus the fine fibular medullary cavity, the fixation is also more reliable, its fixation will help to fix the tibial fracture and its stability. Internal fixation of the fibula fracture is commonly used clinically to assist in the treatment of severe comminuted tibial fractures, not only for pilon fractures; this is especially true when the tibia is fixed with an external fixator. The lower tibia is an area of poor blood supply, with a high incidence of bone discontinuity or delayed healing. Therefore, I am accustomed to treat these comminuted fractures with internal fixation of the fibula and external fixation of the super ankle joint, if the manipulative repositioning is successful, the closed operation is ideal, and if it is really difficult, limited incision can be used to assist in the repositioning, which is less injurious and has less impact on the blood supply. 3. The above treatment is based on the premise that the early debridement is complete and the patient has no local inflammatory reaction; otherwise, it is advisable to open the wound and reopen it for debridement and then take the above treatment. I have seen many cases of such patients because of the intravenous use of antibiotics, local inflammatory manifestations are not obvious, stopping the drug that is not the same, I hope the correct judgment. 4. Anatomical plate is an option, but the damage and stripping is still larger, however, its alignment and internal fixation strength are better, but for patients with poor skin conditions, external fixation stent is better. Just for your reference!