OBJECTIVE To investigate the selection of operative methods,timing of operation and the effect of hige-energy distal tibia Pilon fracture. METHODS From July 2006 to December 2009, 29 patients with hige-energy distal tibia Pilon fractures were treated, including 23 males and 6 females with an average age of 36.8 years old ranging from 21 to 54 years. According to Ruedi-Allgower classification on Pilon fractures, there were 3 cases of type I, 16 of type II and 10 of type III. The type I patients were fixed by screws and Kirschner wires and the cases of type II and III were fixed by filmy clover steel plates closed up tibia medial border or tibia lateral anatomical steel plates. All patients were evaluated by the tumid algesic level of ankle joint, gait,the activity of ankle joint according to Mazur score. RESULTS None of patients occurred complications such as deep infection, fractured internal fixation and prolapsed internal fixation. All patients were followed up from 6 to 42 months (averaged 28 months). The time of fracture healing was from 10 to 32 weeks (means 15 weeks). According to the ankle score of Mazur, the results were excellent in 15 cases,good in 10 cases,fair in 3 cases, poor in 1 case. CONCLUSION The step-by-step delayed open reduction and internal fixation for hige-energy distal tibia Pilon fracture is an effective method with fewer complications and good function after the recovery of soft tissue injury. The method can not only mitigate the level of soft tissue injury, but also is beneficial to the early joint motion with rigid fixation.