Early internal fixation of open ankle malleolar fractures is not associated with increased complications: case control study


ankle fractures; delayed fixation; immediate fixation; malleolar fractures; open fractures; open ankle fracture

Published online: Feb 19 2023


Amr Abdelgawad, Ahmed Elabd, John J. Pisquiy, Ahmed M. Thabet

From the Department of Orthopaedic Surgery and Rehabilitation, TTUHSC-El Paso, Paul L. Foster SOM, Elpaso, USA


The timing of definitive fixation of open ankle malleolar fractures is still controversial. This study intended to evaluate the outcome of patients who were managed by immediate definitive fixation in comparison to delayed definitive fixation following open ankle malleolar fractures. This was an IRB approved retrospective case control study of 32 patients who were treated with open reduction and internal fixation (ORIF) for open ankle malleolar fractures at our Level I trauma center 2011-2018. Patients were divided into 2 groups; immediate ORIF group (within 24 hours) and delayed ORIF group (first stage included debridement and external fixator or splinting followed by second stage of delayed ORIF). Outcomes assessed were postoperative complications (wound healing, infection, nonunion). Logistic regression models were used to access the unadjusted and adjusted associations between post- operative complications and selected co factors. The immediate definitive fixation group included 22 patients while the delayed staged fixation group included 10 patients. Gustilo type II and III open fractures were associated with higher complications rate (p-value = 0.012) in both groups. Comparing the 2 groups, There was no increase in complication in the immediate fixation group compared to the delayed group. Complications following open ankle malleolar fractures are usually associated with Gustilo type II and III open fractures. Immediate definitive fixation after adequate debridement was not found to increase complication rate compared to staged management.