title: Management of grade III open dislocated ankle fractures: combined internal fixation with bioabsorbable screws/rods and external fixation.
abstract: BACKGROUND
  Isolated dislocation of the ankle with grade III open fracture has been scarcely reported. These ankle injuries usually involved mortise fractures, complete dislocation of the tibial astragaloid joint, capsuloligamentous structure disruption, and severe soft-tissue damage. There is no well-recognized regimen that would result in desirable outcomes.
  
  
  METHODS
  Sixteen patients with grade III open dislocated ankle fractures were treated immediately with bioabsorbable implants and an external fixator between January 2003 and June 2007. According to the classification system of Gustilo and Anderson, five patients were grade IIIA, seven were grade IIIB, and four were grade IIIC. Surgical interventions included combined internal fixation with bioabsorbable screws/rods and external fixation.
  
  
  RESULTS
  Patients underwent clinical and radiologic examination at an average of 18.1 months after surgery. Outcomes were excellent in seven patients (three IIIA, three IIIB, and one IIIC), good in four (one IIIA, two IIIB, and one IIIC), fair in three (one IIIA, one IIIB, and one IIIC), and poor in two (one IIIB, and one IIIC). In the two patients with poor outcomes, bone defect and cartilage exfoliating in the distal tibia were found during surgery. Painful osteoarthritis in the ankle was discovered 2 years after surgery. Another case had pin tract infections in the external fixator 3 months after surgery. There was no case of late deep infection.
  
  
  CONCLUSIONS
  It may be a reasonable and desirable option that bioabsorbable implants combined with an external fixator be applied for treatment of severe open dislocated ankle fractures.
authors.affiliation: Department of Orthopaedic Surgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China. yesonman@yahoo.com.cn
authors.forename: Tianwen
authors.initials: T
authors.lastname: Ye
authors.forename: Aimin
authors.initials: A
authors.lastname: Chen
authors.forename: Wen
authors.initials: W
authors.lastname: Yuan
authors.forename: Sanhuai
authors.initials: S
authors.lastname: Gou
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery*; D001858:Bone Nails; D001863:Bone Screws; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005597:Fractures, Open / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery; D011859:Radiography; D035583:Rare Diseases; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult