[Open joint fractures of the distal lower leg]

Ninety-five open fractures of the joint at the distal end of the lower leg (73 ankle fractures, 22 fractures of the pylon tibia) were treated between 1970 and 1987. For different reasons (death, amputation, etc.) only 63 could be followed up. The clinical and radiological assessments of 60 patients are presented in this paper. The Weber evaluation (only 18% good-to-excellent results) seemed to be inadequate for grading these cases. Fifty-six percent of the patients rated the results as very good, 37% as good. Radiological signs of post-traumatic arthritis were found in 48% of the cases. Different arthritis rates were found in a subgroup followed up after 1.5 to 6 years, and another subgroup treated earlier (maximum 18 years). In the first subgroup post-traumatic arthritis was found in 20%; in the second group-treated more than 6 years ago-it was 79%. The fact that the outcome of these late results was worse may be because of the severe traumatization 6-18 years ago, but it is more likely that the results were better in the other subgroup as a result of improved procedures. Nowadays a broad-spectrum cephalosporin is administered in the emergency room. All open fractures are operated on as emergency cases as quickly as possible. All bandages applied at the accident site are removed in the operation theater, not before. There the wounds are carefully irrigated and debrided. Rigid internal fixation with a minimum apparatus is applied. Exceptions are made in the case of severe trauma: external fixation is applied to bridge the joint in the correct position.(ABSTRACT TRUNCATED AT 250 WORDS)