Journal List > J Korean Foot Ankle Soc > v.24(1) > 1144010

J Korean Foot Ankle Soc. 2020 Mar;24(1):25-30. Korean.
Published online Mar 13, 2020.
Copyright © 2020 Korean Foot and Ankle Society
Outcomes of Immediate Operative Treatment of Ankle Trimalleolar Open Fractures
Jun-Young Lee, Yong-Jin Cho, Sin-Wook Kang, Yung-Min Cho and Hyun-Bai Choi
Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Corresponding Author: Jun-Young Lee. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, Email:
Received Oct 14, 2019; Revised Jan 03, 2020; Accepted Jan 07, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



Generally, the treatment of ankle trimalleolar open fractures is divided into two stages: external fixation and debridement; and secondary internal fixation. On the other hand, this two-stage operation takes considerable treatment time and is challenging in procedures requiring reduction. The purpose of this study was to evaluate the radiologic and clinical results of an immediate one-stage internal fixation operation considering the wound conditions to overcome two stage operation disadvantages.

Materials and Methods

From September 2009 to January 2018, 24 cases of ankle trimalleolar open fractures, who underwent immediate internal fixation and were followed up for at least one year, were studied retrospectively. The open wound was divided into the Gustilo-Anderson classification. Open reduction and internal fixation were performed on every medial and lateral malleolar fracture. On the other hand, with posterior malleolar fractures, surgical or conservative treatment was performed depending on the fragment size. The radiologic outcome was evaluated using the Burwell and Charnley criteria and American Orthopaedic Foot and Ankle Society (AOFAS) scores, and complications, such as infection and posttraumatic arthritis, were used for the clinical evaluation.


The wound was classified into eight cases (33.3%) of type I, 11 cases (45.8%) of type II, and five cases (20.8%) of type IIIa. The degree of reduction was anatomical, fair, and poor in 16 cases (66.7%), six cases (25.0%), and two cases (8.3%), respectively. The mean AOFAS score was 79 points, and there were complications, such as infection in three cases (12.5%) and post-traumatic arthritis in two cases (8.3%).


Satisfactory results were obtained through immediate surgical treatment in ankle trimalleolar open fractures of types I, II, and IIIa.

Keywords: Ankle; Open; Trimalleolar fracture; Immediate internal fixation


Figure 1
(A) The initial film shows a trimalleolar fracture of the tibia with medial open wound. (B) Gustilo-Anderson II exposition. (C) Postoperative radiograph shows satisfactory position of plate and 4.0 mm cannulated screws.
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Figure 2
(A) A 55-year-old male sustained a right trimalleolar fracture with medial open wound after traffic accident. (B) First, lateral malleolar fracture was fixed using 1/3 semitubular plate, and 4.0 mm cannulated screws were applied. After 2 weeks, Wound infection was observed. (C) After 5 weeks, incision and debridement was done on medial malleolar infective wound.
Click for larger image


Table 2
Comparison with Other Open Ankle Fracture Article
Click for larger image


The point of this thesis was presented by 2018 Autumn Congress of Korean Foot and Ankle Society.

Financial support:This study was supported by research fund from Chosun University Hospital, 2018.

Conflict of interest:None.

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