Background and aim: The clinical management of posterior pilon fractures (PPF) remains a controversy with various surgical fixation techniques induced as the screws or tubular plate. The comparison of stability of fixation methods for PPFs, could help to determine clinical treatment. Therefore, the displacement and stress of fragment fixed via screws, T-plate and tubular plate were studied by finite element analysis method. Materials and methods: A three-dimensional finite element model of normal ankle was established based on the anatomical data from an healthy male volunteer. The PPF model with single fragment were built by cutting the posterior tibial lip parallel to the bimalleolar axis, while the three fixations of screws, T-plate or tubular plate were established and applied on the unstable model. The PPF model with double fragments was cut in sagittal plane based on the PPF model with double fragments, followed by the simulated four fixation methods (two screws or tubular plate fixed to each fragment) applied on the model. The peak displacement and stress on bone or fixation system were identified under the loads of neutrality, external rotation and plantar flexion. Results: For PPF with single fragment, the T-plate system was proved to be superior to screw or tubular plate system in terms of the highest displacement of fracture under neutral loading or external rotation loading. For PPF with double fragments, two tubular plates provide the minimum of fracture displacement under neutral loading or external rotation loading. All fixations performed similarly under the plantar flexion loading while the highest stress on implants or bone around fixations was similar. Conclusions: T-plate can be superior to screws and tubular plate in fracture stability for single segment of PPF. Two tubular plates could be most stable in fixing double segments in PPF, while the medial plating could behave more stable than lateral plating.