Delayed open reduction and fixation of ankle fractures

Because of clinical circumstances in the period from 1970-1980, 26, consecutive ankle fractures were treated by delayed (14-31 days after injury) open reduction and internal fixation. Follow-up examination (two to 12 years) was obtained in 25 patients. Based on clinical performance index, outcome was judged satisfactory in 17 patients (68%). Seventeen (68%) had an anatomic reduction, and 15 (88%) of these 17 had a satisfactory result. Compared to a group of 26 similar patients treated within 24 hours after injury, the major effect of delay was an adverse influence on the probability of achieving an anatomic reduction (p < 0.08). When anatomic reduction was obtained, the performance index in the delayed-treatment group (78.8) was comparable to that in the immediate-treatment group (78.4%). Thus, when immediate fixation is not possible, delayed reduction and fixation of displaced ankle fractures is a reasonable option in some instances and can be seriously considered by the surgeon. Displaced fractures should not be left in a malreduced position because this provides virtually no opportunity for a satisfactory result.