Staged Treatment for Unstable Open Fracture-Dislocation of the Ankle: A Case Report

Jin ParkDepartment of Orthopedic Surgery, College of Medicine, Hallym University, Seoul, South Korea.

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Hyo Beom LeeDepartment of Orthopedic Surgery, College of Medicine, Yonsei University, Seoul, South Korea.

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Gab Lae KimDepartment of Orthopedic Surgery, College of Medicine, Yonsei University, Seoul, South Korea.

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Kyu Hyun YangDepartment of Orthopedic Surgery, College of Medicine, Yonsei University, Seoul, South Korea.

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Abstract

Unstable fracture-dislocation of the ankle is a common lower extremity injury. Treatment is challenging when the fracture-dislocation is open and cannot be treated with conventional open reduction and internal fixation (ORIF). Immediate ORIF may not be possible for severe, unstable ankle injuries, such as those with ischemic foot due to a poor blood supply caused by soft tissue injury, or open fracture-dislocation of the ankle with a deltoid ligament rupture. We described a staged treatment for unstable open fracture-dislocation of the ankle with a deltoid ligament rupture. The first stage involves temporary vertical transarticular pinning combined with external fixation. The second stage involves delayed definitive plating with autogenous bone graft for the bone defect of the distal fibula. This staged management is useful in select emergency cases of unstable open fracture-dislocations of the ankle combined with deltoid ligament rupture for which conventional ORIF cannot be performed.

Corresponding author: Jin Park, MD, PhD, Department of Orthopedic Surgery, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, 150 Sung-an-ro, Kangdonggu, Seoul, 05355, South Korea. (E-mail: parkjinos@gmail.com