OBJECTIVES

To examine the incidence of surgical site complications associated with pronation-abduction ankle fracture-dislocations with an open medial tension wound.

DESIGN

Retrospective case series.

SETTING

Accredited level-1 trauma center.Patients/Participants: Forty-eight open pronation-abduction ankle fracture-dislocations with medial tension failure wounds treated at our institution from 2014 to 2016.

INTERVENTION

Immediate irrigation and debridement along with surgical stabilization of open ankle fracture-dislocation.

MAIN OUTCOME MEASUREMENTS

The primary outcome measure was deep surgical site infection. Secondary outcome measures included other surgical site complications and adverse radiographic events.

RESULTS

A total of five patients (10.4%) developed a deep surgical site infection requiring additional surgical debridements. One of the patients with a deep surgical site infection required a below-knee amputation as a result of sepsis. Adverse radiographic outcomes included three fibular nonunions (6.3%), three implant failures related to syndesmotic fixations (6.3%), one peri-implant fracture (2.1%), and postoperative collapse of the tibial plafond in three patients (6.3%).

CONCLUSIONS

Open pronation-abduction ankle fracture-dislocations with medial tension failure wounds remain a challenging and potentially devastating injury. Our study suggests that with appropriate surgical debridement, early stabilization, and primary wound closure, acceptable outcomes with a relatively low risk of surgical site complications can be achieved.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.