Problems in the diagnosis and treatment of ankle injuries

This paper discusses some of the problems encountered in the diagnosis and treatment of 371 ankle fractures treated at the University of Kansas Medical Center over a 14-year period, 1965-1979. Seven of these injuries required major reconstructive procedures after failure of initial treatment and 11 fractures required eventual ankle arthrodesis. The causes of failures of the initial treatment of these 18 cases are discussed. The extent of involvement of the articular surface of the tibia as seen on the original post-injury roentgenogram correlated closely with the extent of subsequent ankle arthrosis. The second most important prognostic feature was recognition or failure to recognize rupture of the distal tibio-fibular syndesmosis, its reduction, and maintenance of reduction until complete healing had occurred. The importance of stabilization of the fibula, maintaining its anatomic length, is emphasized. Closed reductions were as successful as open reductions and internal fixation only when reduction was accurate and maintained until healing was complete. Extensive injuries, particularly the Dupuytren and pilon fractures, are best treated by open reduction and internal fixation. The surgical techniques are demanding and technical errors must be avoided if optimal results are to be achieved.