Open ankle fractures. The indications for immediate open reduction and internal fixation

Twenty-two patients with open ankle fractures or fracture-dislocations were treated with irrigation and debridement, reduction, and immediate stable internal fixation at an average of six hours from initial evaluation. There were 13 women (59%) and nine men (41%), having an average follow-up period of 32 months (range, five to 111 months). There were six Grade I (27%), 15 Grade II (68%), and one Grade III (5%) injuries. Fractures also were classified according to the Danis-Weber scheme (Type A [three cases]; Type B [eight]; Type C [11]). Excellent results were achieved in 14 patients (64%); good results in five (23%), and poor results in three (13%). There were four minor complications: two superficial would ulcerations, one loss of reduction requiring revision stabilization, and one distal tibiofibular synostosis. There were no deep infections or nonunions. Immediate debridement, irrigation, reduction, and internal fixation of open ankle fractures is clearly indicated in Grade I and clean Grade II open injuries.