Computed tomography (CT) is used in the preoperative planning of many fractures. It is particularly helpful in anatomic regions with complex anatomy and in fractures with complicated patterns. The authors evaluated the use of CT scans in the preoperative planning of pilon fractures. Twenty-two patients were studied with plain radiographs and with CT scans. The fracture pattern, number of fragments, comminution, impaction, and location of the major fracture line were recorded. The CT scan revealed an increased number of fragments in 12 patients, increased impaction in 6 patients, and increased comminution in 11 patients. The operative plan was changed in 14 (64%) patients, and additional information was gained in 18 (82%) patients.