There are serious problems with existing methods of treating pilon fractures of the tibia caused by high-energy trauma. The method chosen to treat these fractures should not raise the risk of infection while effectively restoring the joint surface. We successfully treated a 42-year-old male patient with a pilon fracture caused by high-energy trauma using an arthroscopy-assisted unilateral external fixator and minimally invasive internal osteosynthesis. We used arthroscopy to reposition the fracture fragments and restore the joint surface. The fracture fragments were fixed with screws immediately after being repositioned. We believe that arthroscopy-assisted combined external and minimally invasive internal fixation is the treatment of choice for these fractures. We used external fixation to improve the fracture alignment, arthroscopy for restoring the joint surface, and minimally invasive screws to ensure fragment stability.