Intraarticular tibial fractures (Pilon) which mostly results from axial loading of the tibial distal can lead to challenging problems during orthopedic surgeries. Open reduction and internal fixation have been widely used in the management of low-energy fractures. In high-energy injuries, two-staged treatment protocols have been composed. Thanks to the improvement in the orthopedic philosophy, there has been a reduction in severe complications such as amputation, osteomyelitis, and arthrodesis. However, it is difficult to decide which treatment protocol is the best in Pilon fractures. Serious fractures (AO C2 or C3 or Rudi-Allgower type III) may be treated better with primary arthrodesis and amputation even in some cases. The education and experience of the treating surgeon and the quality of the implant are the determining factors of the success of the various treatment protocols. Although there is no enough evidence whether a protocol is superior to the other, we know that individualizing treatment based on the current experience and available materials as well as the severity of the fracture and the patient, considering the outcomes of all treatment protocols is determinant in the success of the treatment.