Experience with immediate internal fixation combined with primary wound closure in Gustilo–Anderson type IIIA open ankle fractures

Abstract

Open ankle fractures, especially Gustilo–Anderson type III fractures are challenging to manage with controversy over the “best” or “superior” treatment strategy. This study aimed to evaluate the treatment outcome of immediate internal fixation combined with primary wound closure in the management of Gustilo–Anderson type III open ankle fractures. We retrospectively assessed the outcomes of thirty-two patients treated using immediate internal fixation combined with primary wound closure with a minimum follow-up of twenty-four months. At the median follow-up of 38 (24 to 62) months, the mean American Orthopaedic Foot and Ankle Society scale score was 87.22±4.05. The physical component summary score of Short-Form 36 Health Status Survey was 66.63±11.42 and the mental component summary score was 67.31±7.20. Range of motion of Ankle/Foot injured side was 64.56±4.30 degrees, and Range of motion of Ankle/Foot uninjured side was 72.31±3.12 degrees. Visual analog pain scale score was 1.5±0.88 at rest and 3.09±1.17 during activity. According to American Orthopaedic Foot and Ankle Society scale score, the rate of excellent and good outcomes was 90.6%. Postoperative complications were documented, comprising two (6.4%) cases of infection, five (15.6%) cases of wound skin necrosis, one (3.2%) case of postoperative ankle traumatic arthritis, and one (3.2%) case requiring reoperation due to suboptimal fibula fracture reduction. The study results demonstrated that immediate internal fixation combined with primary wound closure for Gustilo–Anderson type III open ankle fractures achieve good functional outcomes and lower complication rates.Level of Evidence: Level IV, retrospective case series.