Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations

To compare the efficacy, functional outcome, and complication frequency of splinting and external fixation in the initial treatment of ankle fracture-dislocations.

Ankles with poor soft tissue conditions who underwent temporary stabilization due to using a splint or external fixator due to an ankle fracture-dislocation between 2012 and 2019 were retrospectively evaluated. Ankles were divided into two groups as the splint (n=69) and external fixator (n=48). The time between the injury to definitive surgery, reduction loss, operation time, functional outcome, pain, and soft-tissue complication frequency before and after definitive surgery were compared.

The frequency of reduction loss (25% vs. 4%, p=0.019) and skin necrosis (22% vs. 6%, p=0.028) were significantly higher in the splint group. Posterior malleolar fracture fragment ratio was calculated by dividing the fracture fragment axial length by the total axial length of the articular surface on computed tomography. Posterior malleolar fracture fragment ratio was found to be significantly higher in ankles with reduction loss in both the splint (25% vs 75%, p=0.032) and fixator groups (4% vs 96%, p=0.021). The mean time period between injury and definitive surgery was significantly shorter in the external fixator group (11±5 vs 7±4 days, p=0.033). Before definitive treatment, pin tract infection was observed in two ankles in the fixator group.

Splint immobilization of ankle fracture-dislocations may predispose to reduction loss, soft tissue complications, and a longer time period between injury and definitive fixation. The risk of these potential complications can be reduced with the use of an external fixator.