J Korean Foot Ankle Soc.  2020 Mar;24(1):25-30. 10.14193/jkfas.2020.24.1.25.

Outcomes of Immediate Operative Treatment of Ankle Trimalleolar Open Fractures

• Lee JY
• Cho YJ
• Kang SW
• Cho YM
• Choi HB

• KMID: 2502905
• DOI: http://doi.org/10.14193/jkfas.2020.24.1.25

Abstract

Purpose
Generally, the treatment of ankle trimalleolar open fractures is divided into two stages: external fixation and debridement; and secondary internal fixation. On the other hand, this two-stage operation takes considerable treatment time and is challenging in procedures requiring reduction. The purpose of this study was to evaluate the radiologic and clinical results of an immediate one-stage internal fixation operation considering the wound conditions to overcome two stage operation disadvantages.
Materials and Methods
From September 2009 to January 2018, 24 cases of ankle trimalleolar open fractures, who underwent immediate internal fixation and were followed up for at least one year, were studied retrospectively. The open wound was divided into the Gustilo- Anderson classification. Open reduction and internal fixation were performed on every medial and lateral malleolar fracture. On the other hand, with posterior malleolar fractures, surgical or conservative treatment was performed depending on the fragment size. The radiologic outcome was evaluated using the Burwell and Charnley criteria and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and complications, such as infection and posttraumatic arthritis, were used for the clinical evaluation.
Results
The wound was classified into eight cases (33.3%) of type I, 11 cases (45.8%) of type II, and five cases (20.8%) of type IIIa. The degree of reduction was anatomical, fair, and poor in 16 cases (66.7%), six cases (25.0%), and two cases (8.3%), respectively. The mean AOFAS score was 79 points, and there were complications, such as infection in three cases (12.5%) and post-traumatic arthritis in two cases (8.3%).
Conclusion
Satisfactory results were obtained through immediate surgical treatment in ankle trimalleolar open fractures of types I, II, and IIIa.

Keyword

Ankle; Open; Trimalleolar fracture; Immediate internal fixation

Figure

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  Figure 1. (A) The initial film shows a trimalleolar fracture of the tibia with medial open wound. (B) Gustilo-Anderson II exposition. (C) Postoperative radiograph shows satisfactory position of plate and 4.0 mm cannulated screws.

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  Figure 2. (A) A 55-year-old male sustained a right trimalleolar fracture with medial open wound after traffic accident. (B) First, lateral malleolar fracture was fixed using 1/3 semitubular plate, and 4.0 mm cannulated screws were applied. After 2 weeks, Wound infection was observed. (C) After 5 weeks, incision and debridement was done on medial malleolar infective wound.

Reference

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