Causes, complications, and treatment of open ankle fracture
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20223577Keywords:
Open fracture, Ankle fracture, InfectionAbstract
Open ankle fractures are uncommon (3-6%) among all ankle fractures. Emerging trends show that the incidence of low-energy open ankle fractures is prevalent in older women. The mechanism of open fracture management continues to pose difficulties for orthopaedic surgeons. A simple fall is responsible for just under half of all fractures caused by motor vehicle collisions (MVCs). Despite technological advancements and surgical methods, infectious and non-infectious rates remain problematic. The mainstay of care is to combine antibiotic therapy with thorough irrigation and debridement. To prevent additional soft tissue and vascular damage, these fractures must be stabilized immediately, preferably with an external fixator. When the residual infection has cleared and the soft tissue envelope is adequate, do a definitive open reduction and internal fixation, adapting the procedure to the patient and type of fracture. Functional outcomes could be enhanced by taking safeguards against preventable comorbidities to reduce postoperative complications.
Metrics
Metrics Loading ...
References
Koval KJ, Lurie J, Zhou W. Ankle fractures in the elderly: what you get depends on where you live and who you see. J Orthop Trauma. 2005;19(9):635-9.
2. Thur CK, Edgren G, Jansson K, Wretenberg P. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop. 2012;83(3):276-81.
3. Simske NM, Audet MA, Kim C-Y, Vallier HA. Open ankle fractures are associated with complications and reoperations. OTA Int. 2019;2(4).
4. Thur CK, Edgren G, Jansson K-Å, Wretenberg P. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop. 2012;83(3):276-81.
5. Bugler KE, Clement ND, Duckworth AD, White TO, McQueen MM. Open ankle fractures: who gets them and why? Arch Orthop Trauma Surg. 2015;135(3):297-303.
6. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453-8.
7. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742-6.
8. Bugler KE, Clement ND, Duckworth AD, White TO, McQueen MM, Court-Brown CM. Open ankle fractures: who gets them and why? Arch Orthop Trauma Surg. 2015;135(3):297-303.
9. Ovaska MT, Madanat R, Honkamaa M, Mäkinen TJ. Contemporary demographics and complications of patients treated for open ankle fractures. Injury. 2015;46(8):1650-5.
10. Koval KJ, Lurie J, Zhou W. Ankle fractures in the elderly: what you get depends on where you live and who you see. J Orthop Trauma. 2005;19(9):635-9.
11. Simske NM, Audet MA, Kim CY, Vallier HA. Open ankle fractures are associated with complications and reoperations. OTA Int. 2019;2(4):e042.
12. Zaghloul A, Haddad B, Barksfield R, Davis B. Early complications of surgery in operative treatment of ankle fractures in those over 60: a review of 186 cases. Injury. 2014;45(4):780-83.
13. Elniel AR, Giannoudis PV. Open fractures of the lower extremity: Current management and clinical outcomes. EFORT Open Rev. 2018;3(5):316-25.
14. Cross WW, 3rd, Swiontkowski MF. Treatment principles in the management of open fractures. Ind J Orthop. 2008;42(4):377-86.
15. Anglen JO. Wound irrigation in musculoskeletal injury. J Am Academy Orthop Surg. 2001;9(4):219-26.
16. Museru LM, Kumar A, Ickler P. Comparison of isotonic saline, distilled water and boiled water in irrigation of open fractures. Int Orthop. 1989;13(3):179-80.
17. Fernandez R, Griffiths R. Water for wound cleansing. Cochrane database Systematic Rev. 2012(2):Cd003861.
18. Bhandari M, Jeray KJ, Petrisor BA. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. N Eng J Med. 2015;373(27):2629-41.
19. Olufemi OT, Adeyeye AI. Irrigation solutions in open fractures of the lower extremities: evaluation of isotonic saline and distilled water. Sicot-j. 2017;3:7.
20. Bray TJ, Endicott M, Capra SE. Treatment of open ankle fractures. Immediate internal fixation versus closed immobilization and delayed fixation. Clin Orthop Rel Res. 1989(240):47-52.
21. Hassinger SM, Harding G, Wongworawat MD. High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop Rel Res. 2005;439:27-31.
22. Bhandari M, Schemitsch EH, Adili A, Lachowski RJ, Shaughnessy SG. High and low pressure pulsatile lavage of contaminated tibial fractures: an in vitro study of bacterial adherence and bone damage. J Orthop Trauma. 1999;13(8):526-33.
23. Boyd III JI, Wongworawat MD. High-pressure pulsatile lavage causes soft tissue damage. Clin Orthop Rel Res (1976-2007). 2004;427:13-7.
24. Dirschl DR, Duff GP, Dahners LE, Edin M, Rahn BA, Miclau T. High pressure pulsatile lavage irrigation of intraarticular fractures: effects on fracture healing. J Orthop Trauma. 1998;12(7):460-3.
25. Hassinger SM, Harding G, Wongworawat MD. High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop Rel Res. 2005;439:27-31.
26. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. New Eng J Med. 2015;373(27):2629-41.
27. Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Rel Res. 1989;243:36-40.
28. Dellinger EP, Caplan ES, Weaver LD. Duration of preventive antibiotic administration for open extremity fractures. Arch Surg. 1988;123(3):333-9.
29. Anderson A, Miller AD, Brandon Bookstaver P. Antimicrobial prophylaxis in open lower extremity fractures. Open Access Emergency Med. 2011;3:7-11.
30. Li J, Qin L, Yang K. Materials evolution of bone plates for internal fixation of bone fractures: A review. J Materials Sci Technol. 2020;36:190-208.
31. White CB, Turner NS, Lee G-C, Haidukewych GJ. Open Ankle Fractures in Patients With Diabetes Mellitus. Clin Orthop Rel Res. 2003;414.
32. Hulsker CCC, Kleinveld S, Zonnenberg CBL, Hogervorst M, van den Bekerom MPJ. Evidence-based treatment of open ankle fractures. Arch Orthop Trauma Surg. 2011;131(11):1545-53.
33. Buckley R, Kwek E, Duffy P. Single-Screw Fixation Compared With Double Screw Fixation for Treatment of Medial Malleolar Fractures: A Prospective Randomized Trial. J Orthop Trauma. 2018;32(11):548-53.
34. Galante VN, Vicenti G, Corina G. Hybrid external fixation in the treatment of tibial pilon fractures: a retrospective analysis of 162 fractures. Injury. 2016;47:S131-7.
35. Meena UK, Bansal MC, Behera P, Upadhyay R, Gothwal GC. Evaluation of functional outcome of pilon fractures managed with limited internal fixation and external fixation: A prospective clinical study. J Clin Orthop Trauma. 2017;8:S16-20.
36. Sen MK. Combined limited internal fixation and multiplanar external fixation for immediate weight bearing of fractures around the foot and ankle. OTA Int. 2022;5(3).
37. Coles CP. Open fractures with soft-tissue loss: Coverage options and timing of surgery. OTA Int. 2020;3(1).
38. Mehta D, Abdou S, Stranix JT. Comparing Radiographic Progression of Bone Healing in Gustilo IIIB Open Tibia Fractures Treated With Muscle Versus Fasciocutaneous Flaps. J Orthop Trauma. 2018;32(8):381-5.
39. Paro J, Chiou G, Sen SK. Comparing Muscle and Fasciocutaneous Free Flaps in Lower Extremity Reconstruction-Does It Matter? Ann Plastic Surg. 2016;76.
40. Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78(3):285-92.
41. Cavo MJ, Fox JP, Markert R, Laughlin RT. Association Between Diabetes, Obesity, and Short-Term Outcomes Among Patients Surgically Treated for Ankle Fracture. J Bone Joint Surg Am. 2015;97(12):987-94.
42. Costigan W, Thordarson DB, Debnath UK. Operative management of ankle fractures in patients with diabetes mellitus. Foot Ankle Int. 2007;28(1):32-7.
43. McCormack RG, Leith JM. Ankle fractures in diabetics. Complications of surgical management. J Bone Joint Surg Bri. 1998;80(4):689-92.
44. Blotter RH, Connolly E, Wasan A, Chapman MW. Acute complications in the operative treatment of isolated ankle fractures in patients with diabetes mellitus. Foot Ankle Int. 1999;20(11):687-94.
45. Wukich DK, Joseph A, Ryan M, Ramirez C, Irrgang JJ. Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes. Foot Ankle Int. 2011;32(2):120-30.
46. Sun Y, Wang H, Tang Y. Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: A retrospective multicenter study. Medicine. 2018;97(7):e9901.
47. Bose D, Kugan R, Stubbs D, McNally M. Management of infected nonunion of the long bones by a multidisciplinary team. Bone Joint J. 2015;97-b(6):814-7.
48. Joseph J, Giannoudis PV, Hinsche A, Cohen A, Matthews SJ, Smith RM. Compartment syndrome following isolated ankle fracture. Int Orthop. 2000;24(3):173-5.
49. Guo S, Sethi D, Prakash D. Compartment syndrome of the foot secondary to fixation of ankle fracture-A case report. Foot Ankle Surg. 2010;16(3):e72-5.
2. Thur CK, Edgren G, Jansson K, Wretenberg P. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop. 2012;83(3):276-81.
3. Simske NM, Audet MA, Kim C-Y, Vallier HA. Open ankle fractures are associated with complications and reoperations. OTA Int. 2019;2(4).
4. Thur CK, Edgren G, Jansson K-Å, Wretenberg P. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop. 2012;83(3):276-81.
5. Bugler KE, Clement ND, Duckworth AD, White TO, McQueen MM. Open ankle fractures: who gets them and why? Arch Orthop Trauma Surg. 2015;135(3):297-303.
6. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453-8.
7. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742-6.
8. Bugler KE, Clement ND, Duckworth AD, White TO, McQueen MM, Court-Brown CM. Open ankle fractures: who gets them and why? Arch Orthop Trauma Surg. 2015;135(3):297-303.
9. Ovaska MT, Madanat R, Honkamaa M, Mäkinen TJ. Contemporary demographics and complications of patients treated for open ankle fractures. Injury. 2015;46(8):1650-5.
10. Koval KJ, Lurie J, Zhou W. Ankle fractures in the elderly: what you get depends on where you live and who you see. J Orthop Trauma. 2005;19(9):635-9.
11. Simske NM, Audet MA, Kim CY, Vallier HA. Open ankle fractures are associated with complications and reoperations. OTA Int. 2019;2(4):e042.
12. Zaghloul A, Haddad B, Barksfield R, Davis B. Early complications of surgery in operative treatment of ankle fractures in those over 60: a review of 186 cases. Injury. 2014;45(4):780-83.
13. Elniel AR, Giannoudis PV. Open fractures of the lower extremity: Current management and clinical outcomes. EFORT Open Rev. 2018;3(5):316-25.
14. Cross WW, 3rd, Swiontkowski MF. Treatment principles in the management of open fractures. Ind J Orthop. 2008;42(4):377-86.
15. Anglen JO. Wound irrigation in musculoskeletal injury. J Am Academy Orthop Surg. 2001;9(4):219-26.
16. Museru LM, Kumar A, Ickler P. Comparison of isotonic saline, distilled water and boiled water in irrigation of open fractures. Int Orthop. 1989;13(3):179-80.
17. Fernandez R, Griffiths R. Water for wound cleansing. Cochrane database Systematic Rev. 2012(2):Cd003861.
18. Bhandari M, Jeray KJ, Petrisor BA. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. N Eng J Med. 2015;373(27):2629-41.
19. Olufemi OT, Adeyeye AI. Irrigation solutions in open fractures of the lower extremities: evaluation of isotonic saline and distilled water. Sicot-j. 2017;3:7.
20. Bray TJ, Endicott M, Capra SE. Treatment of open ankle fractures. Immediate internal fixation versus closed immobilization and delayed fixation. Clin Orthop Rel Res. 1989(240):47-52.
21. Hassinger SM, Harding G, Wongworawat MD. High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop Rel Res. 2005;439:27-31.
22. Bhandari M, Schemitsch EH, Adili A, Lachowski RJ, Shaughnessy SG. High and low pressure pulsatile lavage of contaminated tibial fractures: an in vitro study of bacterial adherence and bone damage. J Orthop Trauma. 1999;13(8):526-33.
23. Boyd III JI, Wongworawat MD. High-pressure pulsatile lavage causes soft tissue damage. Clin Orthop Rel Res (1976-2007). 2004;427:13-7.
24. Dirschl DR, Duff GP, Dahners LE, Edin M, Rahn BA, Miclau T. High pressure pulsatile lavage irrigation of intraarticular fractures: effects on fracture healing. J Orthop Trauma. 1998;12(7):460-3.
25. Hassinger SM, Harding G, Wongworawat MD. High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop Rel Res. 2005;439:27-31.
26. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. New Eng J Med. 2015;373(27):2629-41.
27. Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Rel Res. 1989;243:36-40.
28. Dellinger EP, Caplan ES, Weaver LD. Duration of preventive antibiotic administration for open extremity fractures. Arch Surg. 1988;123(3):333-9.
29. Anderson A, Miller AD, Brandon Bookstaver P. Antimicrobial prophylaxis in open lower extremity fractures. Open Access Emergency Med. 2011;3:7-11.
30. Li J, Qin L, Yang K. Materials evolution of bone plates for internal fixation of bone fractures: A review. J Materials Sci Technol. 2020;36:190-208.
31. White CB, Turner NS, Lee G-C, Haidukewych GJ. Open Ankle Fractures in Patients With Diabetes Mellitus. Clin Orthop Rel Res. 2003;414.
32. Hulsker CCC, Kleinveld S, Zonnenberg CBL, Hogervorst M, van den Bekerom MPJ. Evidence-based treatment of open ankle fractures. Arch Orthop Trauma Surg. 2011;131(11):1545-53.
33. Buckley R, Kwek E, Duffy P. Single-Screw Fixation Compared With Double Screw Fixation for Treatment of Medial Malleolar Fractures: A Prospective Randomized Trial. J Orthop Trauma. 2018;32(11):548-53.
34. Galante VN, Vicenti G, Corina G. Hybrid external fixation in the treatment of tibial pilon fractures: a retrospective analysis of 162 fractures. Injury. 2016;47:S131-7.
35. Meena UK, Bansal MC, Behera P, Upadhyay R, Gothwal GC. Evaluation of functional outcome of pilon fractures managed with limited internal fixation and external fixation: A prospective clinical study. J Clin Orthop Trauma. 2017;8:S16-20.
36. Sen MK. Combined limited internal fixation and multiplanar external fixation for immediate weight bearing of fractures around the foot and ankle. OTA Int. 2022;5(3).
37. Coles CP. Open fractures with soft-tissue loss: Coverage options and timing of surgery. OTA Int. 2020;3(1).
38. Mehta D, Abdou S, Stranix JT. Comparing Radiographic Progression of Bone Healing in Gustilo IIIB Open Tibia Fractures Treated With Muscle Versus Fasciocutaneous Flaps. J Orthop Trauma. 2018;32(8):381-5.
39. Paro J, Chiou G, Sen SK. Comparing Muscle and Fasciocutaneous Free Flaps in Lower Extremity Reconstruction-Does It Matter? Ann Plastic Surg. 2016;76.
40. Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78(3):285-92.
41. Cavo MJ, Fox JP, Markert R, Laughlin RT. Association Between Diabetes, Obesity, and Short-Term Outcomes Among Patients Surgically Treated for Ankle Fracture. J Bone Joint Surg Am. 2015;97(12):987-94.
42. Costigan W, Thordarson DB, Debnath UK. Operative management of ankle fractures in patients with diabetes mellitus. Foot Ankle Int. 2007;28(1):32-7.
43. McCormack RG, Leith JM. Ankle fractures in diabetics. Complications of surgical management. J Bone Joint Surg Bri. 1998;80(4):689-92.
44. Blotter RH, Connolly E, Wasan A, Chapman MW. Acute complications in the operative treatment of isolated ankle fractures in patients with diabetes mellitus. Foot Ankle Int. 1999;20(11):687-94.
45. Wukich DK, Joseph A, Ryan M, Ramirez C, Irrgang JJ. Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes. Foot Ankle Int. 2011;32(2):120-30.
46. Sun Y, Wang H, Tang Y. Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: A retrospective multicenter study. Medicine. 2018;97(7):e9901.
47. Bose D, Kugan R, Stubbs D, McNally M. Management of infected nonunion of the long bones by a multidisciplinary team. Bone Joint J. 2015;97-b(6):814-7.
48. Joseph J, Giannoudis PV, Hinsche A, Cohen A, Matthews SJ, Smith RM. Compartment syndrome following isolated ankle fracture. Int Orthop. 2000;24(3):173-5.
49. Guo S, Sethi D, Prakash D. Compartment syndrome of the foot secondary to fixation of ankle fracture-A case report. Foot Ankle Surg. 2010;16(3):e72-5.
Downloads
Published
2022-12-29
How to Cite
Sunbol, K. M., Alsulami, S. N., AlSharif, A. M., Alshammari, D. A., Alshehri, M. F., Abu Alsaud, S. H., Alkhoshiban, S. K., Alghamdi, A. S., Almohisin, E. A., Alabbas, F. M., & Al Ghamdi, R. N. (2022). Causes, complications, and treatment of open ankle fracture. International Journal Of Community Medicine And Public Health, 10(1), 474–479. https://doi.org/10.18203/2394-6040.ijcmph20223577
Issue
Section
Review Articles
