Inclusion Criteria:  Age ≥ 60 years with frailty as defined by a Dalhousie Clinical Frailty Scale score ≥5 Isolated fracture: an AO/OTA C2 or C3 tibial pilon fracture or severe ankle fracture (fracture-dislocation, severe joint impaction, severe trimalleolar) Severe soft tissue compromise or significant co-morbidities (vascular disease + chronic trophic changes, diabetes + neuropathy, chronic renal failure, morbid obesity (BMI> 40))  Exclusion Criteria:  Presence of vascular injury or pathologic fracture; Previous tibia pilon fracture or retained hardware in affected limb; Refusal to participate; Inability to provide informed consent; Inability to speak/understand or read English without a registered interpreter