Comparison of Temporary External Fixation and Open Reduction with Internal Fixation for the Management of Pilon Fractures: A Short-Term Outcome Prospective Clinical Trial.

Objectives: Pilon fractures are among the difficult injuries to treat in orthopedic surgery. We aim to evaluate the feasibility, advantages, and disadvantages of temporary external fixation for pilon fractures and compare its outcomes with cases managed with internal fixation and primary open reduction.

Methods: In a prospective trial, 30 patients were divided into two cohorts: a two-stage cohort with external fixation and secondary ORIF (15 patients) and a one-stage primary ORIF cohort (15 patients). We compared the two cohorts' rates of infection (deep or superficial infection), non-union, malunion, length of hospital stay, patient satisfaction with the American Orthopaedic Foot and Ankle Society (AOFAS) score, and pain level.

Results: All assessed variables showed no significant variations between the two cohorts, except for hospital stay duration, which was substantially more prolonged in the two-stage cohort.

Conclusion: This study demonstrates that both temporary external fixation with secondary ORIF and primary ORIF are viable options for managing pilon fractures. While there were no significant differences in complications between the two treatment modalities, the two-stage approach was associated with a longer hospital stay. These findings suggest that primary ORIF may be preferable when aiming to reduce the duration of hospitalization without compromising clinical outcomes.