Clinical Outcomes of Single-Stage Surgical Intervention for Open Pronation-External Rotation Ankle Fracture-Dislocation.

Abstract

Open pronation-external rotation (PER) ankle fracture-dislocations are severe injuries requiring urgent surgical treatment, but evidence on single-stage management remains limited. To evaluate the clinical outcomes of single-stage surgical treatment in patients with open PER ankle fracture-dislocations without neurovascular injury. Retrospective case series. We retrospectively reviewed 58 patients with open PER ankle fracture-dislocations without neurovascular compromise treated between December 2013 and July 2024 at the Hospital. All underwent emergency debridement with open reduction and internal fixation in a single stage, with negative-pressure wound therapy when required. Postoperative complications were recorded. Functional outcomes were assessed at final follow-up using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale. Radiographic evaluation included syndesmotic diastasis, malreduction, and post-traumatic arthritis. Most patients (84.5%) underwent surgery within 8 hours after injury. According to the Gustilo-Anderson classification, 22 fractures (37.9%) were type II, 28 (48.3%) were type IIIA, and 8 (13.8%) were type IIIB. Traffic accidents were the most common mechanism of injury (44.8%). Deep surgical site infection occurred in 7 patients (12.1%), and 19 patients (32.8%) required reoperation. Arthrodesis was performed in 4 patients (6.9%). Post-traumatic arthritis developed in 9 patients (15.5%). The mean AOFAS score at final follow-up was 76.3 ± 9.8. Single-stage surgical management of open PER ankle fracture-dislocations may be associated with relatively high rates of infection, reoperation, and complications. Careful patient selection and consideration of staged treatment strategies may be warranted.