Objective To study the efficacy of spanning external fixation plus simple internal fixation for Type Ⅲ Pilon fracture. Methods This study enrolled 26 patients with type Ⅲ Pilon fracture. They underwent spanning external fixation plus simple internal fixation with Kirschner wire. Results All patients were followed up for 10-18 months (average 12 months), the healing time was 18 to 25 weeks (average 20 weeks), 13 cases had excellent results, 10 cases good and 3 cases fair according to Mazur’s criteria. The excellent and good rate was 88%. The wounds healed well except that 2 cases developed pin-related infection, There were no delay fracture healing and nonunion, nor vessel and accessory nerve injury. Conclusions Type Ⅲ Pilon fracture is difficult to deal with because of the poor skin condition and the severe comminuted fracture. It cannot be fixed by plate and screws. Spanning external fixation plus simple internal fixation is the best way for type Ⅲ Pilon fracture. It is relatively simple, easy to learn and can minimize the operative trauma. It has advantages of early movement and less complications.