Introduction: Based on a previous mapping study which detailed pilon fracture patterns, a distal tibial implant was designed to address common zones of comminution and primary fracture fragments in pilon fractures. The purpose of this study is to determine if this plate design properly addresses the most common OTA/AO type 43C3 fracture patterns. Methods: This anteriorly based implant features removable distal tabs which can buttress anterior plafond comminution, two kickstand screw trajectories which address the typical posterolateral and medial fragments, and a distal A to P screw pattern which allows for a raft above the plafond apex. All patients treated using this plate for the pilon fracture between September 2011 and June 2012 were prospectively enrolled. Injury radiographs and CT scans performed after application of external fixators and all postoperative radiographs were reviewed. An assessment of how the plate addressed the fracture pattern was performed for each patient. Results: Twenty consecutive OTA/AO type 43C3 tibial pilon fractures (11 R/9 L) were enrolled. The cohort consisted of 14 males and 6 females, with a mean age of 43 years (range, 23-61). There were three open fractures. Fourteen of the 20 fractures (70%) had an associated fibula fracture; all which were fixed through a separate incision. Eighteen of the 20 (90%) were consistent with the published Pilon Map. In the series, seven 3-hole, four 5-hole, five 9-hole and four 13-hole pates were used. 78% of the kickstand screws were used (15 medial, 16 lateral) addressing the medial malleolar and/or posterolateral fragment. Thirty-nine of the 60 (65%) distal tabs for the anterior comminution of the fracture were utilized. Of the 20 cases, only 2 (10%) had separate medial buttress plates applied. Discussion: A new custom anterior pilon plate designed to address tibia pilon mapping data, consistently addressed the fracture patterns in OTA/AO type 43C3 tibial pilon fractures. This study provides the basis for a comparative outcome study.