Soft Tissue Complications Following Temporary External Fixation vs Splinting of Trimalleolar Ankle Fractures

Temporary management of closed trimalleolar ankle fractures may involve closed reduction and splint application vs external fixation (ex-fix). One of the primary concerns of using splinting is loss of reduction and soft tissue compromise. The objective of this study was to determine if there is a clinically significant difference in short-term soft tissue complications (STCs) in patients with trimalleolar or trimalleolar-equivalent ankle fractures treated with temporary closed reduction and splinting vs ex-fix.

In this multicenter retrospective review from 2 level 1 trauma centers, patients with closed trimalleolar ankle fractures treated surgically from 2017 to 2022 were identified. Demographic data, surgical details, radiographic data, and postoperative details were reviewed and collected to determine postoperative soft tissue complications.

Overall, 488 patients met inclusion criteria; 395 patients (80.9%) were managed with temporary splinting and 93 with ex-fix (19.1%). Median follow-up was 24 weeks (range 8-292). The cohort's STC rate was 8.4% (41 of 488), including 2.9% (14 of 488) that required reoperation and 5.5% (27 of 488) that required nonoperative treatment. STC occurred in 6 of 93 ex-fix patients (6.5%) and 35 of 395 temporary splinting patients (8.9%) (risk difference -2.4% [95% CI -7.1% to 4.9%]; OR 0.70 [95% CI 0.28-1.74]; P = .45). Reoperation for STC occurred in 3 of 93 ex-fix patients (3.2%) and 11 of 395 temporary splinting patients (2.8%) (risk difference 0.4% [95% CI -2.5% to 6.4%]; OR 1.16 [95% CI 0.31-4.25]; P = .73).

The results suggest similar rates of STC with ex-fix and temporary splinting before definitive fixation of ankle fractures with a posterior malleolus component. Surgeons must consider if there is a benefit to use ex-fix, considering the additional cost and burden to patients.