Immediate internal fixation of open ankle fractures

Open ankle fractures are one of the most frequently treated open fractures. Immediate internal fixation in open ankle fractures is widely reported to produce good results, with a very low infection rate. However, there are few reports in the literature discussing distinct features of open ankle fractures. Thus, the aim of this study was to explore the injury features of such fractures and the operative technique; pilon fractures were excluded.

Ninety-six patients with open ankle fractures underwent surgery between August 2001 and March 2008. Ninety-two patients were followed for an average of 35 (range, 14 to 66) months. Intravenous antibiotics were initiated in the emergency room, and wounds were copiously irrigated and thoroughly debrided in the operating room as soon as possible. Based on the fracture's classification, the extent of comminution, and the wound condition, a rational sequence of treatment for each malleolar fracture was determined. Reduction and internal fixation of the fractures were performed in turn.

Primary wound healing was achieved in 65 patients. Superficial skin necrosis was seen in 19 patients, four patients had delayed wound healing and two had superficial infections. One diabetic patient developed a deep infection. The average time of fracture healing was 13 weeks. The mean AOFAS ankle-hindfoot score was 90.4 (range, 59 to 100).

Compared with closed ankle fractures, open ankle fractures have some unique injury features, and correspondingly require special treatment methods with respect to soft-tissue handling, restoration of large posterior malleolar fractures, the reconstruction sequence of malleolar fractures, and the management of distal tibiofibular syndesmotic diastasis.