Tibial pilon fractures constitude 1% of lower extremity fractures and approximately 7–10% of all tibial fractures. These fractures are often occurs after a high-energy injury and 85% of pilon fractures are accompanied by fibula fracture. Good results after surgical treatment of pilon fractures depends on the quality of articular reduction, providence of methaphysodiaphyseal alignment and stable fixation that could provide early mobilization. Although detection of accompanying fibula fractures is important in terms of lengthening, rotation and alignment, ensuring stable fixation provides additional stability to the tibia fixation. Although screw-plaque is the conventional method in the fixation of fibula fractures accompanying pilon fractures, intramedullary implants can also be used in the fixation and both techniques have advantages and disadvantages when compared. Fixation of fibula fractures accompanying pilon fractures is recommended in order to get better functional outcomes after surgical treatment of pilon fractures, and experience to a lesser extent tibial malunion and post-traumatic ankle arthritis.