Rittmann WW, Schibli M, Matter P, et al: Open fractures: long-term results in 200 consecutive cases. .Clin Orthop Relat Res 138::132. ,1979. .
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 24::742. ,1984. .
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 58::453. ,1976. .
Chapman MW, Mahoney M: The role of early internal fixation in the management of open fractures. .Clin Orthop Relat Res 138::120. ,1979. .
Anderson JT, Gustilo RB: Immediate internal fixation in open fractures. .Orthop Clin North Am 11::569. ,1980. .
Johnson EE, Davlin LB: Open ankle fractures: the indications of immediate open reduction and internal fixation. .Clin Orthop Relat Res 292::118. ,1993. .
Ketenjian AY, Shelton MJ: Primary internal fixation of open fractures: a retrospective study of use of metallic fixation in fresh open fractures. .J Trauma 12::756. ,1972. .
Johanson U: View point on primary osteosynthesis in compound fractures. .Acta Chir Scand 105::474. ,1953. .
McNeuer JC: The management of open skeletal trauma with particular reference to internal fixation. .J Bone Joint Surg Br 52::54. ,1970. .
Gristina AG, Rovere GD: An in vitro study of the effects of metals used in internal fixation on bacterial growth and dissemination. .J Bone Joint Surg Am 45::1104. ,1963. .
Patzakis MJ, Wilkins J, Moore TM: Use of antibiotics in open tibial fractures. .Clin Orthop Relat Res 178::31. ,1983. .
Salter RB, Simmonds DF, Malcolm BW, et al: The biological effects of continuous passive motion on healing of full thickness defects in articular cartilage. .J Bone Joint Surg Am 62::1232. ,1980. .
Yokoyama K, Shindo M, Itoman M, et al: Immediate internal fixation for open fractures of the long bones of the upper and lower extremities. .J Trauma 37::230. ,1994. .
Heier KA, Infante AF, Walling AK, et al: The natural history of and treatment of open calcaneal fractures. .J Orthop Trauma 14::141. ,2000. .
Franklin JL, Johnson KD, Hansen ST Jr: Immediate internal fixation of open ankle fractures: report of thirty-eight cases treated with a standard protocol. .J Bone Joint Surg Am 66::1349. ,1984. .
Conroy J, Agarwal M, Giannoudis PV, et al: Early internal fixation and soft tissue cover of severe open tibial pilon fractures. .Int Orthop 27::343. ,2003. .
In this prospective study, 30 patients (28 men and 2 women) with open ankle fractures were treated with early debridement and immediate stable internal fixation after anatomical reduction to achieve better functional results after early mobilization. The procedure was performed an average of 8 hours (range, 6–15 hours) after injury. According to the classification system of Gustilo and Anderson, 11 fractures (37%) were grade I, 12 (40%) were grade II, 5 (17%) were grade IIIA, and 2 (7%) were grade IIIB. Six complications occurred: four patients had superficial skin necrosis and two had loss of reduction, resulting in residual ankle stiffness. Twenty patients had excellent results, eight had good results, and two had fair results according to the modified criteria of Ketenjian and Shelton. We found that immediate debridement, anatomical reduction, and internal fixation of open ankle fractures leads to better functional results, especially in grade I and grade II injuries. (J Am Podiatr Med Assoc 96(2): 120–124, 2006)