Tibiotalar Joint Stabilization by Steinman Pins in Oestern-tscherne Type III Open Fracture Dislocation of the Ankle

Abstract

Aim: Open fracture-dislocation of the ankle is a high-energy limp-threading injury, almost always associated with vary grades of soft tissue damage. Stabilization of the tibiotalar joint by Steinman pins is retrospectively evaluated and seems to favor the management of the soft tissue damage and probably minimize the rate of complications in diabetic patients. Study Design: Retrospective case series study. Place and Duration of Study: From 2003 to 2011, Department of Orthopedics and Traumatology, University of Athens Medical School, KAT Hospital Athens, Greece. Materials and Methods: 17 patients were admitted with a fracture dislocation of the ankle. Twelve were featured as Oestern-Tscherne type III and 5 as type V. There have been used Steinmann pins to provide a rigid stabilization of the ankle in anatomic position, and available enough space to observe, follow and manage the soft tissue damage during the entire period of treatment. Two groups were confronted according to associated co-morbidity of diabetes mellitus. Results: At their last follow up visit, 14 patients were evaluated and the mean AOFAS score was 86, 5. The mean follow up period was 18, 1 months. Five patients underwent secondary arthrodesis of tibiofibular joint and in 4 patiens were observed non union of the fibula. Intra operatively in 10 patients were observed osteochondral post-traumatic lesions. In 3 patients the talus demonstrated signs of AVN at 7 months after trauma. There was no statistical difference between the two groups studied. Conclusions: Immediate débridement, irrigation, antibiotic therapy and use of Steinmann pins to stabilize the tibiotalar joint are indicated in a way to reduce the complication rates in diabetic patients. This technique seems to be effective and low cost, evidenced by the unnecessary use of further wound and soft tissue treatment operations.