Does age matter? Outcomes of pilon fracture fixation in patients above and below 40 years: A comparative study

Pilon fractures are complex intra-articular injuries of the distal tibia often caused by high-energy trauma. Although ORIF remains the gold standard for restoring alignment and joint congruity, the influence of patient age on clinical and radiographic outcomes remains unclear. This study aimed to compare healing, complication rates, and functional outcomes between patients below and above 40 years old following ORIF of Pilon fractures.

A prospective comparative study was conducted on 56 tibial Pilon fractures in 55 patients. Patients were stratified into two groups according to age: < 40 years (35 fractures) and ≥ 40 years (21 fractures). Functional outcomes were assessed using the AOFAS and Olerud-Molander scores. Radiographic union, alignment, and complications rates were assessed in both groups.

Among 56 included patients, both age groups showed comparable demographics and fracture characteristics. Falls were the most common mechanism of injury, followed by MVA. All fractures healed successfully, with a mean union time of 15.1 ± 2.7 weeks and no significant difference between both groups. Functional outcomes (AOFAS and OMS) were comparable between groups without statistical significance. Although postoperative complications were more frequent in older patients (47.6% vs. 22.9%), no significant difference was detected and no nonunion or implant failure occurred.

Age did not significantly influence healing or functional outcomes after ORIF of Pilon fractures. Despite slightly longer union time and a higher rate of complications in older patients, both groups achieved comparable recovery. These findings suggest that satisfactory outcomes can be achieved across different age groups when appropriate staged management and fixation principles are applied.

Level 4.