Long-term outcomes following bilateral pilon fractures: a report of three cases.

We present three male patients who sustained bilateral pilon fractures following high-energy trauma, including falls and motor vehicle collisions. All patients had comorbidities such as obesity, tobacco use, and cardiovascular, or psychiatric conditions. Each underwent staged open reduction and internal fixation using contemporary techniques tailored to fracture pattern and soft tissue status. Over a minimum follow-up of 2 years, two patients experienced significant late complications, including distal tibial nonunion and symptomatic post-traumatic arthritis. These required revision procedures, such as iliac crest bone grafting, tibiotalar arthrodesis, and subtalar fusion, >1 year after index surgery. This is the first case series to report long-term outcomes following bilateral pilon fractures. Our findings underscore the importance of extended postoperative surveillance and suggest that bilateral injuries may portend a more complex recovery. Further research is warranted to guide prognosis, optimize treatment, and improve counseling for patients with complex bilateral lower extremity trauma.