We describe the surgical technique, assessment, and complications in patients undergoing arthroscopic reduction and internal fixation for distal tibial intra-articular fractures. Between December 2005 and September 2010, 8 patients underwent surgery. Mean follow-up time was 44 months (range, 8 to 65 mo). Mean age was 44 years (range, 35 to 65 y); 7 patients were male. AO classification was 4.3.C.1 in 3 patients and 4.3.C.3 in 5. Anatomic reduction was successfully achieved in all patients. Consolidation time was between 3 and 6 months for all cases. During follow-up, no loss of reduction was identified by x-ray. One patient suffered regional complex pain syndrome. One patient presented osteoarthritis at 48-month follow-up. In the late follow-up, 1 patient presented chronic osteomyelitis of distal tibia. At final follow-up, AOFAS hindfoot median score was 75 and abbreviated SF 36 median scores were 59 and 77 for the physical and mental components, respectively. In selected patients, arthroscopic assistance may aid in the reduction of distal tibia fractures by allowing direct control of the articular surface and may obtain better results than radioscopic control alone.