Mandatory open reduction: its role in displaced ankle fractures.

"Satisfactory reduction" is insufficient in discussing ankle fractures; only perfect anatomic reduction will suffice. Fractures extending into joint surfaces carry a higher incidence of disability than those involving the metaphysis and/or diaphysis. The end result is further adversely affected when such fractures occur in weight-bearing joints with resulting disability from persistent pain and stiffness. It is our belief that anatomic reduction of displaced ankle fractures, especially the restoration of fibular length, is almost impossible by closed reduction. Closed reduction may require frequent manipulation and plaster changes as the swelling subsides, and the fragments become displaced. This encourages ankle and subtalar stiffness. For these reasons mandatory open reduction and rigid internal fixation of these fractures are recommended. A review of 300 nonconsecutive cases of open and closed displaced ankle fractures treated by open reduction had an overall infection rate of 1% and an incidence of degenerative arthritis of 3%.