Fractures of the distal tibia including the articular surfaces have considerably increased. A simple classification based on the surgical findings is recommended and some particular diagnostic criteria are pointed out. The operative approach and technique have been described in detail. Due to special osteosynthetic implants alignment of the axis, anatomical reconstruction of the articular surfaces, and stabilisation in comminuted fractures has been greatly facilitated. Cancellous bone from the ipsilateral proximal tibia is advantageous for the filling of metaphyseal defects in juvenile patients. Post-operative treatment has to be individualized with emphasis on functional treatment. Between 1963 and 1973, 128 osteosynthetic reconstructions for fracture of the distal tibia have been performed. Primary fusion was not necessary in any patients. 121 patients could be reviewed an average of 4 years after injury. Late complications (delayed healing, refracture, late infection etc.) were rare (about 7%) and healed without further sequelae. Secondary correction of the axis or fusions were not required. In 90% the functional results after these serious fractures were good. 85% returned to athletic activity, only 5% are disabled.