To clarify which factors influence the final result of surgical management of plafond or pilon fractures, 66 patients with 67 pilon fractures treated at the Orthopaedic Department of the University of Athens between 1978 and 1993 were reviewed. There were eight (11.95%) Type I, 33 (49.25%) Type II, and 26 (38.8%) Type III fractures according to the Ruedi-Allgower classification. Eleven (16.4%) were open injuries. Fifty of the 67 fractures were treated by internal fixation following the AO principles, whereas minimal osteosynthesis was performed in nine cases, and the remaining eight cases were managed by external fixation. The final outcome of the treatment was evaluated after 2 to 17 years followup (mean, 8.1 years) and was based on the subjective, objective, and radiographic results of each case, using the method of Burwell and Charnley. The findings indicate that three parameters significantly influenced the outcome of plafond fracture management. Specifically, the results of surgical management were affected by the clinical type of the fracture, the quality of reduction achieved at surgery, and the specific surgical procedure by which the fracture was managed.