Open Fractures of the Ankle: Management Options and Factors influencing Outcomes

Abstract

ABSTRACT Open ankle fractures are rare injuries among all the ankle fractures and commonly occur after high-velocity trauma in road traffic accidents resulting in varying amounts of soft-tissue loss, periosteal stripping, microbial contamination, bone loss, and vascular injury. Management of open ankle fractures remains a daunting task due to the complex osseo-ligamentous complex, relatively thin soft-tissue coverage around the joint, propensity for wound infection and complications, and the risk of impaired functional ability. Management in the emergency trauma room includes initial stabilization of the patient, focused history, and detailed clinical evaluation determining the level and type of injury, extent of wound contamination, soft-tissue and/or bone loss, and neurovascular status of the injured limb followed by radiographic evaluation. Early antibiotics administration and wound assessment, irrigation, aseptic dressing, and temporary splintage form the cornerstone of initial orthopedic stabilization of open fractures. There is a general consensus that all open ankle fractures need early debridement and fixation to restore articular congruity and alignment of fracture fragments although the timing of internal/definitive fixation of open ankle fractures is still debatable. Common complications include superficial and deep infections, marginal skin necrosis, compartment syndrome, nonunion/malunion, and secondary osteoarthritis. Timely interventions improve orthopedic outcomes in these patients. How to cite this article Saini UC, Dhillon MS, Cheema U, Rajnish RK. Open Fractures of the Ankle: Management Options and Factors influencing Outcomes. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):69-76.