Clinical outcomes of pilon fractures of tibia may vary depending on severity of trauma, status of soft tissues, choice of treatment, comorbidities, and postoperative rehabilitation. Careless handling of soft tissues during surgical procedure may cause problems that are troublesome to treat afterwards. Contemporarily, despite of understanding of the importance of soft tissues and development of newer implant technologies, complications may still be encountered after pilon fractures of the tibia. The most common early postoperative complications are superficial skin necrosis and wound dehiscence. While the superficial skin necrosis could be treated with local wound care, deep infections require debridement and use of antibiotics. Late complications include malunion, union delay, nonunion, osteomyelitis, and post-traumatic arthrosis. Especially late infections or nonunions caused by osteomyelitis are very difficult to treat. All of the implants, besides the necrotic and infected bone tissue are removed completely with repetitive debridements. Bone defects are augmented with antibiotics loaded bone cement. External fixators may be used to stabilize the fracture until the infection is under control. Arthrodesis of the ankle joint is considered to be the most reliable treatment of advanced arthrosis. Obtaining a normal alignment of tibia, and a complete fracture healing is required to perform arthrodesis. Blade plates, fusion nails, ring external fixators may be used to perform arthrodesis. Ankle joint arthroplasty is another treatment choice of symptomatic post-traumatic ankle joint arthrosis. But for this procedure, healthy soft tissue coverage, minimal deformity, and vascularized bone are necessary. Such complications as wound healing problems, fractures of medial or lateral malleoli, and loosening of components may be seen after an ankle arthroplasty.