Delayed open reduction and fixation of ankle fractures

Because of clinical circumstances in the period from 1970-1980, 26 consecutive ankle fractures were treated by delayed (14-31 days after injury) open reduction and internal fixation. Follow-up examination (two to 12 years) was obtained in 25 patients. Based on clinical performance index, outcome was judged satisfactory in 17 patients (68%). Seventeen (68%) had an anatomic reduction, and 15 (88%) of these 17 had a satisfactory result. Compared to a group of 26 similar patients treated within 24 hours after injury, the major effect of delay was an adverse influence on the probability of achieving an anatomic reduction (p less than 0.08). When anatomic reduction was obtained, the performance index in the delayed-treatment group (78.8) was comparable to that in the immediate-treatment group (78.4%). Thus, when immediate fixation is not possible, delayed reduction and fixation of displaced ankle fractures is a reasonable option in some instances and can be seriously considered by the surgeon. Displaced fractures should not be left in a malreduced position because this provides virtually no opportunity for a satisfactory result.