Objective The incidence of posterior pilon variant fractures has been underestimated. The purpose was to study the characteristics of posteromedial (PM) and posterolateral (PL) fragments in CT imaging of posterior pilon variant fractures, and to provide help for clinical diagnosis and treatment. Methods CT imaging data of 109 cases of posterior pilon variant fractures in our hospital from January 2013 to December 2020 were retrospectively analyzed. According to Mason and Molloy classification, PM fragments were further divided into pilon subtypes and avulsed subtypes. The largest actual area of fragments in axial and sagittal were selected as the study plane, and the maximum axial lengths of X , Y and Z , α angle, β angle, fragment area (S1–7) and fragment area ratio (FAR1-4), interfragmentary (IF) angle, and back of tibia (BT) angle were measured. Results A total of 109 cases were included in this study, 61 of whom were pilon subtypes 90.16% were supination-external rotation (SER) injuries. 48 cases were avulsed subtypes 81.25% were pronation-external rotation (PER) injuries. Pilon subtypes were larger than avulsed subtypes in X , Y , Z , α 2 Angle, β 2 Angle, fragment area and ratio, and IF and BT angle ( P  < 0.05). There was no difference between α 1 and β 1 angle ( P  > 0.05). Conclusion The morphology of pilon subtype was larger than that of avulsion subtype. According to fragment size, morphology, and injury mechanism, two fragments of pilon subtype should be anatomic reduction and fixation. However, the PL fragment of avulsion subtype should to be fixed, while PM fragment may only need conservative treatment.