Abstract: Management of Pilon fractures continue to be unsolved mystery for Orthopaedic surgeons even in today’s modern era. Earlier, majority of these fractures were to be treated by conservative management only for want of improved surgical techniques and implants resulted in wound complications and poor functional outcome in terms of range of motion at ankle joint, pain and associated joint stiffness. Majority of the patients land up with ankle arthrodesis and amputations especially in 43-C3 fractures. With advancement and improvisation of our knowledge in anatomy and biomechanics of the distal tibia and with improved surgical techniques, now the trend has been shifted from conservative towards operative approach to manage such fractures showing dramatic improvements functionally. Despite all the efforts, dilemma still persists for the correct method to choose for management of such injuries. In order to vein off such confusion, a comparison has been studied between two cases of open grade 3B Pilon fractures managed by two different methods.