RESUMO
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.
RESUMO
Eighty long bone open fractures were treated with immediate internal fixation within an average of 7.4 hours after trauma from June, 1984 to September, 1989. Mean follow-up was 17 months ranging from 1 year to 3 years and 4 months. Fifty-four tibia, 11 femur, 9 forearm, and 6 humerus open fractures were encountered. According to Gustilo and Anderson's wound classification, there were 19 Type I, 26 Type II, and 35 Type III open fractures. Internal fixation was facilitated with plate and screws in 58 cases, Ender nails in 13 cases, Kuntscher nails in 3 cases, and screws only in 5cases. Bone grafting was performed in 47 cases. Uncomplicated union was achieved in 16cases (84 %) in type I, 23 cases (88%) in Type II, and 18 cases (51%) in Type III. Transient soft tissue infection was noted in 3 cases(16%) in Type I, 3 cases(8%) in Type II, and 5 cases(14%) in Type III. Transient osteomyelitis was present in 1 caes(4%) in Type II, and 4 cases(11%) in Type III, and all were resolved within 1 month. Three cases of Type III open fractures where mutilated injury was associated with severe vascular injuries were ended up with amputation. Five unions (14%) in Type III were complicated with chronic osteomyelitis. Overall uncomplicated union was achieved in 38 cases (87%) in Type I & II, and 18 cases (51%) in Type III. Soft tissue coverage especially with viable muscle and stable fixation with good cortical contact seemed to be important prognostic factors. While there exists potential disadvantages of higher minor and major complication rates and more sophisticated management of the patient, this one-stage open reduction and internal fixation with bone graft which converts open fracture into stable closed fracture might be of some value especially in Type I & II open fractures in terms of simultaneous management of fracture and open wound, prevention of secondary infection, anatomical reduction including joint congruity, stable maintenance of reduction, elimination of deformity, and early joint motion.