Tibial plafond or pilon fractures account for 5 to 10% of all lower extremity fractures and are associated with high energy trauma. They are the result of predominantly axial loading resulting in a typical three fragment and comminuted pattern. These fractures have a high rate of non-union, mal-union, and wound healing issues due to weak metaphyseal bone, a lack of robust soft tissue coverage, and complex intra-articular extension. Early studies demonstrating higher rates of complications after acute management have promoted a strategy of “staged” management. In this approach, the initial injury is initially stabilized with the use of temporary external fixation and definitive fixation is delayed until soft tissues are amenable to primary closure of incisions. While staged management has been considered the standard of practice, more recent work has reported good outcomes with acute definitive fixation in well selected patients. In this manuscript and video, we demonstrate a tibial pilon fracture managed acutely with a hybrid fixation approach combining internal fixation with external fixation.