Grade III open ankle fractures--a review of the outcome of treatment.

A retrospective review of fifteen patients with Grade III open ankle fractures, admitted to the Singapore General Hospital from January 1980 to December 1990 was done. Nine of the patients were males with a mean age of 47 years. Road traffic and industrial accidents accounted for 12 of the cases. Eleven of the fractures were associated with ankle dislocation or subluxation. Eleven of the fractures were fixed with plate and screws. Two of the ankles were stabilised with Steinmann pins inserted from the calcaneum to the lower end of the tibia. In ten cases the wounds were closed primarily or by delayed primary closure. One case required a flap to cover the defect and the rest were skin grafted. Eleven were immobilised in a plaster cast ranging from six to twelve weeks. Superficial infection was found in three cases and deep infection involving the bone and joint was present in three. Range of motion at one year was satisfactory in eleven but poor in two. Seven patients developed osteoarthritis of the ankle and three had ankle arthrodesis for pain and instability.