Functional Outcomes of Pilon Fractures Treated by External Fixation, Delayed Plating, and Open Reduction and Internal Fixation (ORIF): A Prospective Cohort Study

Objective: This study aimed to evaluate the functional outcomes of three surgical management strategies for pilon fractures, including primary external fixation with delayed plating, external fixation with minimal internal fixation, and single-stage open reduction and internal fixation (ORIF) with plating.

Methods: This prospective cohort study included 34 patients with complex intra-articular fractures of the distal tibia (AO-OTA type 43-C) treated between June 2018 and December 2019. Patients were managed surgically based on the local skin condition and swelling, employing either primary-stage external fixation with delayed plating (Group A), external fixation with minimal internal fixation (Group B), or single-stage ORIF with plating (Group C). Patients were followed up at regular intervals (six weeks, three months, six months, and 12 months post-surgery). Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS) and Foot and Ankle Disability Index (FADI). Statistical significance was set at p<0.05.

Results: The mean age of patients was 41±12.34 years. Group C included 23 patients (67.7%), Group B included five patients (14.7%), and Group A included six patients (17.6%). There were no significant differences between groups regarding the mechanism of injury, hospital stay duration, complications, or final functional scores (p>0.05). Group C showed significantly better AOFAS and FADI scores at six weeks and three months compared to the other groups; however, by six and 12 months, no significant differences were observed between the groups.

Conclusion: While ORIF with plating (Group C) demonstrated superior short-term functional outcomes, no long-term differences were observed between the three surgical approaches for pilon fractures. These findings suggest that all three methods can be viable options, with choice depending on individual patient factors and surgeon preference.