The Use of External Fixation in the Initial Management of Ankle Fractures

Displaced closed ankle fractures are associated with injury to overlying skin and subcutaneous tissue. Determination of the severity of injury to the soft tissues is an important component of patient assessment and affects management of closed fractures. Studies of surgically treated displaced ankle fractures demonstrated a higher short-term incidence of soft tissue complications in the peri-operative course when there was a significant primary soft tissue injury. This series includes 18 cases with displaced ankle fractures associated with severe soft tissue injury, swelling and/or fracture blister. They were treated by initial reduction and external fixation. As soft tissue injuries resolved the external fixator was removed and the fracture was treated by open reduction and internal fixation. All fractures healed with minor soft tissue complication, and a good functional result. A two-staged approach achieving good functional outcome with no major peri-operative soft tissue complications is a safe approach and offers acceptable results for the treatment of severe displaced ankle fractures with closed soft tissue injury.