External and limited internal fixation in the treatment of open Gustilo-Anderson Grade III ankle fractures: A single-center retrospective cohort study

Background: The treatment of Gustilo-Anderson grade III open distal tibia fractures remains controversial, and often results in serious complications, including amputation. External fixation combined with limited internal fixation (EFLIF) can provide stability and exert beneficial effects on the fracture. This study evaluated the functional and clinical outcomes of EFLIF in patients with Gustilo-Anderson grade III open distal tibia fractures. Methods We retrospectively reviewed the clinical and follow-up data of 36 patients with open distal tibia fracture treated in our hospital between January 2017 and July 2021. We excluded cases lost to follow-up and those who underwent amputation. The data analysis included 26 patients with Gustilo-Anderson grade III fractures. The patients were followed up for traumatic surface recovery, ankle complications, and ankle function. The American Orthopedic Foot & Ankle score (AOFAS) was used to evaluate the functional outcomes. Results The 26 patients were followed up for 6–24 (mean, 14) months. Based on the AOFAS, the outcome in 17 patients was excellent, good in five, medium in three, and poor in one. No patient experienced incision breakdown, postoperative infection, or fracture nonunion. Conclusion The EFLIF can achieve positive outcomes when used to treat open distal tibia fractures. Sometimes, it can be considered the first line of treatment for open distal tibia fractures.