Management of Severe Open Ankle–Foot Trauma by a Simple External Fixation Technique: An Alternative During War and in Resource-Poor and Low-Technology Environments

Abstract

Severe open foot and ankle injuries are still a challenge for the orthopaedic surgeon. Their treatment is even more difficult in third world countries and in war settings where high-energy trauma with severe soft tissue damage is more frequent. Lack of equipment, poor resources and hygiene, and different cultural systems make most of the standard proposed treatments difficult to apply. The authors describe an inexpensive, rapid, minimally invasive, and easy-to-apply external fixation technique for the treatment of severe open ankle-foot fractures. With the main goal of soft tissue management rather than definitive treatment of any bony injuries, this technique was developed over time during many consecutive missions in Sierra Leone and Afghanistan as an alternative to more appropriate treatments with surprisingly satisfactory short- and long-term results.

Limb Salvage of Ankle Fracture Dislocation With LIMA External Fixator

“…2,7 They concluded that external fixation is a minimally invasive treatment for open fracture dislocations and facilitates better care of the skin and soft tissues. 2 7 The authors believe that both internal and external fixation have their associated risks and benefits. The present case study illustrates the benefit of combining the 2 aforementioned techniques in a staged, standardized protocol.…”

“…After approximately 18 months of follow-up, the authors reported fair to excellent results in all but 2 patients, who had painful osteoarthritis 2 year after the surgery. 2,7 They concluded that external fixation is a minimally invasive treatment for open fracture dislocations and facilitates better care of the skin and soft tissues. 2 Khan et al 3 compared the management of open ankle injuries with ORIF and external fixation; among the various complications, 4 cases of deep infection necessitated hardware removal in the ORIF group.…”

“…3 Some studies have reported a lower incidence of infection with external fixation as compared with plate fixation in open tibial fractures. 7 The authors believe that both internal and external fixation have their associated risks and benefits. The present case study illustrates the benefit of combining the 2 aforementioned techniques in a staged, standardized protocol.…”

A Novel Uni- and Biplanar External Fixator for Initial and Definitive Complex Foot Trauma

“…Although multiple treatment strategies have been proposed, ranging from immobilization with casts to open reconstructions, 15 the fact remains that there is currently no universally accepted standard for treating this condition. In this regard, one possibility is to perform a staged procedure, with the premises of initially realigning the foot and achieving adequate stability.…”