Comparative Study of Functional Outcomes and Infection Profiles in Pilon Fractures Managed by Plating, External Fixation, and Conservative Methods

Background: Pilon fracture injuries remain a challenge due to their complex fracture patterns, associated soft-tissue damage, and high risk of complications. This study aimed to evaluate and compare the functional and microbiological outcomes of pilon fractures managed by plating, external fixation, and conservative methods. Materials and Methods: A prospective analysis was conducted on 25 patients with pilon fractures treated by different modalities – plating, external fixation, and conservative methods. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system at 6 months and 1 year postinjury. Results: A total of 25 patients were included. Arbeitsgemeinschaft für osteosynthesefragen type 43C fractures were predominant ( n = 20, 80%) compared to type 43B ( n = 5, 20%). Partial weight-bearing was achieved earliest in the plating group (9.1 ± 1.55 weeks), followed by conservative treatment (9.6 ± 1.51 weeks) and external fixation (10.6 ± 0.89 weeks), with no significant difference ( P = 0.1544). Full weight-bearing occurred significantly earlier with plating (14.93 ± 1.09 weeks) compared to external fixation (17.0 ± 1.73 weeks) and conservative treatment (16.2 ± 2.58 weeks). Union times were comparable among the groups. Functional outcomes, assessed using the AOFAS score at 6 months, showed that the plating group achieved the highest scores (70.2 ± 2.41) compared to external fixation (68.5 ± 2.10) and conservative management (65.8 ± 3.56), with a significant difference. Conclusion: Open reduction and internal fixation with plating provided superior functional recovery, earlier rehabilitation, and higher AOFAS scores compared to other modalities. Overall, functional outcomes were fair across modalities, with treatment choice requiring a balance between optimal mobility and infection prevention.