Temporizing External Fixation vs Splinting Following Ankle Fracture Dislocation.

Area of Science:

• Orthopedic surgery
• Traumatology
• Emergency medicine

Background:

• Closed reduction and splinting is standard for ankle fractures.
• Ankle fracture-dislocations may require different management due to reduction loss risk.
• This study evaluates complications of splinting versus external fixation for unstable ankle fracture-dislocations.

Purpose of the Study:

• Determine complication rates of closed reduction and splinting for unstable ankle fracture-dislocations.
• Assess the efficacy of immediate external fixation as an alternative to splinting.
• Compare splinting and external fixation in cases too swollen for acute operation.

Main Methods:

• Retrospective chart review of ankle fracture-dislocations (2008-2018).
• Excluded patients with acute ORIF or open fractures.
• Compared splinting (n=28) versus external fixation (n=28) for temporization.

Main Results:

• Splint group: 50% loss of reduction, 17.6% skin necrosis.
• External fixation group: 0% loss of reduction, 0% skin necrosis.
• Redislocation and skin necrosis rates were significantly higher with splinting (P < .01 and P = .05).

Conclusions:

• Splint immobilization of ankle fracture-dislocations increases risks of redislocation and skin necrosis.
• External fixation is a safer temporizing option compared to splinting.
• These findings suggest external fixation should be considered for unstable ankle fracture-dislocations unsuitable for immediate ORIF.