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Background: The timing of surgery for osteosynthesis of type C pilon (AO/OTA) fractures remains controversial.The aim of this study was to determine the outcome of early and delayed open reduction and internal fixation (ORIF) for treating closed type C pilon fractures.Methods: Forty-six patients with closed type C pilon fractures matched according to age, gender, soft tissue conditions, and fracture pattern were divided into group A (early group: underwent surgery within 36 hours of the injury) or group B (delayed group: underwent surgery 10 days to 3 weeks postinjury after the soft tissue swelling subsided).In the delayed group, 9 patients were treated first by temporary external fixation.All the closed fractures were managed by ORIF with locking plates.At follow-up, the clinical and radiographic results were retrospectively analyzed.The mean follow-up time was 25.8 months (range, 14 to 48 months) in group A and 26.0 months (range, 15 to 44 months) in group B.Results: There was no significant difference (P >.05) between the 2 groups regarding the rate of soft tissue complication, the rate of fracture union, and the final functional score.The patients in group A had a significantly shorter mean time to fracture union (21.5 ± 4.0 weeks vs 23.3 + 3.7 weeks, P <0.05), operating time (84.3 ± 12.1 months vs 100.6 ± 13.7 months, P <0.01), and hospital stay (7.6 ± 2.6 days vs 15.2 ± 4.2 days,P <0.01).Conclusion: If soft tissue conditions are acceptable, early ORIF for treating closed type C pilon fractures can be safe and effective, with similar rates of wound complication, fracture union, and final good functional recovery but shorter operative time, union time, and hospital stay.These results favorably compare with delayed ORIF treatment.