Surgical treatment of displaced ankle fractures

To test the validity of the practice of open reduction and internal fixation for the treatment of displaced ankle fractures, 25 cases were reviewed after a mean follow-up period of 1.5 years. Eighty-eight per cent had satisfactory objective results and 76% satisfactory subjective results. Eight-eight per cent of the patients with good results had anatomic reductions, whereas none of those with poor results was anatomically reduced. No patient with anatomic reduction had early evidence of degenerative arthritis. There were no nonunions of the medial malleolus, and open fractures did not predispose to poor results. The pronation-eversion injury as classified by Lauge-Hansen was found to have the poorest results objectively, with 70% fair or poor subjectively. This observation is believed to be due to the complete ligamentous disruption of the syndesmosis, which, unlike intraosseous diastasis, fails to heal solidly in a high percentage of patients. This study indicates that good results can be achieved by open reduction and internal fixation when exact anatomic reduction is achieved. The pronation-eversion injury remains a difficult problem. Better methods of treatment for this injury are needed.