Objective To compare and analyze the effects of distal tibial locking compression plate (LCP) and anatomical plate internal fixation on Pilon fractures. Methods A total of 71 patients with Pilon fractures admitted to the hospital from January 2018 to June 2020 were selected. According to the method of random number table, 36 patients in the study group were treated with LCP of distal tibia, and 35 patients in the control group were treated with anatomical plate internal fixation.The clinical indexes, the excellent and good rate of Mazur score, and the incidence rate of complications were compared between the two groups. Results The operation time, surgical incision length, hospital stay, and fracture healing time in the study group were all shorter than those in the control group (P<0.05). After 12 months of follow-up, the excellent and good rate of Mazur score in the study group was 97.22%, which was significantly higher than that in the control group, 77.14% (P<0.05). The incidence rate of complications in the study group was 2.78%, which was significantly lower than that in the control group, 25.71% (P<0.05). Conclusion Distal tibial LCP in the treatment of Pilon fractures can significantly promote fracture reduction, healing, and ankle function recovery, with a low complication rate, which is worthy of clinical promotion.