Department of Orthopaedic Traumatology, Tianjin Orthopedics Hospital, Tianjin 300211, China.
Foot Ankle Int. 2010 Nov;31(11):959-64. doi: 10.3113/FAI.2010.0959.
Open ankle fractures are one of the most frequently treated open fractures. Immediate internal fixation in open ankle fractures is widely reported to produce good results, with a very low infection rate. However, there are few reports in the literature discussing distinct features of open ankle fractures. Thus, the aim of this study was to explore the injury features of such fractures and the operative technique; pilon fractures were excluded.
Ninety-six patients with open ankle fractures underwent surgery between August 2001 and March 2008. Ninety-two patients were followed for an average of 35 (range, 14 to 66) months. Intravenous antibiotics were initiated in the emergency room, and wounds were copiously irrigated and thoroughly debrided in the operating room as soon as possible. Based on the fracture's classification, the extent of comminution, and the wound condition, a rational sequence of treatment for each malleolar fracture was determined. Reduction and internal fixation of the fractures were performed in turn.
Primary wound healing was achieved in 65 patients. Superficial skin necrosis was seen in 19 patients, four patients had delayed wound healing and two had superficial infections. One diabetic patient developed a deep infection. The average time of fracture healing was 13 weeks. The mean AOFAS ankle-hindfoot score was 90.4 (range, 59 to 100).
Compared with closed ankle fractures, open ankle fractures have some unique injury features, and correspondingly require special treatment methods with respect to soft-tissue handling, restoration of large posterior malleolar fractures, the reconstruction sequence of malleolar fractures, and the management of distal tibiofibular syndesmotic diastasis.
开放性踝关节骨折是最常治疗的开放性骨折之一。广泛报道，在开放性踝关节骨折中立即进行内固定可产生良好的效果，感染率非常低。然而，文献中很少有报道讨论开放性踝关节骨折的独特特征。因此，本研究旨在探讨此类骨折的损伤特征和手术技术；排除了 Pilon 骨折。
2001 年 8 月至 2008 年 3 月期间，96 例开放性踝关节骨折患者接受了手术治疗。92 例患者平均随访 35 个月（范围，14 至 66 个月）。在急诊室开始静脉使用抗生素，并尽快在手术室充分冲洗和彻底清创伤口。根据骨折的分类、粉碎程度和伤口情况，确定每个外踝骨折的合理治疗顺序。依次进行骨折的复位和内固定。
65 例患者实现了一期伤口愈合。19 例患者出现浅表皮肤坏死，4 例患者出现延迟伤口愈合，2 例患者出现浅表感染。1 例糖尿病患者发生深部感染。骨折愈合的平均时间为 13 周。AOFAS 踝关节-后足评分平均为 90.4（范围，59 至 100）。
与闭合性踝关节骨折相比，开放性踝关节骨折具有一些独特的损伤特征，因此在软组织处理、大后踝骨折的复位、外踝骨折的重建顺序以及下胫腓联合分离的处理方面需要特殊的治疗方法。
