ABSTRACT Background Pilon fracture is common clinical joint fracture and difficult to treat. It has high requirements on reduction and fixation. The selection of treatments is challengeable. In order to recover the ankle function maximize, there are many treatments proposed in paper recently, but no further studies. Therefore, patients of our hospital with Pilon fracture were followed up and the treatments were compared by different operations. Materials and methods Eighty-eight patients from August 2003 to October 2010 treated with conservative treatment, open reduction and internal fixation, external fixation combined with limited open reduction and internal fixation and external fixation were retrospectively analyzed. Results Seventy-eight cases were followed up in 88 patients, 66 cases were treated with operation. Postoperative complications: malunion in 7 cases, wound infection and delayed healing in 5 cases, delayed union in 2 cases and traumatic arthritis in 4 cases. At the same time, ankle function of type III Pilon fracture after operation was scored by Tornetta. Conclusion choose a suitable operation style and time according to Pilon fracture type and degree of soft tissue and use external fixator combined with limited internal fixation for fracture reduction properly, a good clinical effect can be achieved after surgery. How to cite this article Chu H, Yu H, Zhu K, Ren D, Xu X, Huang H. Analysis of the Operative Treatment for Pilon Fracture. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):86-89.