Primary Screw Fixation of the Medial Malleolus in Highly Unstable Ankle Fracture-dislocations as an Alternative to Temporary Ankle-spanning External Fixation

Closed reduction combined with temporary ankle-spanning external fixation is the gold standard if immediate open reduction and internal fixation is not feasible or closed reduction may not be maintained in highly unstable fracture-dislocations of the ankle. Although external fixation is a quick and technically simple procedure, considerable operation-related complications have been reported in the literature. As an alternative, primary reduction and screw fixation of the medial malleolus may provide sufficient stability to maintain adequate reduction of the ankle joint. With this approach, potential problems of external fixation may be avoided, and the operating time of definitive open reduction and internal fixation is shortened. Level of Evidence: Level V.