To determine outcomes following acute versus staged fixation of complete articular tibial plafond fractures. Retrospective cohort study. Single Level 1 Trauma center. 98 skeletally mature patients with OTA/AO 43C type fractures who underwent definitive fixation with plate and screw constructs and had minimum 6 month follow up. Acute (aORIF) versus staged (sORIF) definitive fixation. Rates of wound dehiscence/necrosis and deep infection. Acute (N=40) versus staged (N=58) ORIF groups had comparable rates of vascular disease, renal disease, and substance/nicotine use, but aORIF patients had higher rates of diabetes mellitus (10% vs 0%, p<0.001), which correlated with higher ASA scores (>ASA 3: 37.5% vs 13.8%, p=0.02). Both groups achieved anatomic/good reductions, as determined by post-operative CT scans, at rates greater than 90%; however, the sORIF group required modestly longer operative times to achieve this outcome (aORIF vs sORIF: 121 vs 146 minutes, p=0.02). Post-operatively, both groups had similar rates of wound dehiscence (2.5% vs 6.9%, p=0.65), superficial (10% vs 17.2%, p=0.39), and deep (10% vs 8.6%, p=0.99) infections. While the injury pattern itself required free flap coverage in 1 patient in each group, unplanned free flap coverage occurred in 10.0% and 10.3% of aORIF and sORIF groups, respectively. Overall, rates of unplanned reoperations, excluding ankle arthrodesis, did not differ between groups (aORIF vs sORIF:12.5% vs 25.9%, p=0.13). In select patients managed by fellowship trained Orthopaedic traumatologists, acute definitive pilon fixation can produce acceptable outcomes.