2009 Volume 21 Issue 1 Pages 123-129
We report two cases of open ankle fracture with deficits of the bone and cartilage. In the first case, a 25-year-old man fell from his motorcycle and was transferred to our emergency and critical care center. His right foot had been partially amputated at the ankle. The posterior tibial artery was ruptured at the injury site, and so the classification of the open fracture was Gustilo IIIC. We performed emergency reconstruction of the posterior tibial artery and internal fixation with K-wires, and covered the skin deficit using artificial cutis. On the 4th day after injury, we performed skin grafting and reconstruction of the ankle joint using a bone block from ilium, resulting in a non-union partial arthrodesis of the ankle joint. At 22 months after the operation, the patient had slight pain in the ankle joint, but was able to return to work. In the second case, a 50-year-old man suffered from injuries in a motor vehicle accident. On arrival, the patient had a wide open wound around the lateral ankle and foot area with deficits of the soft tissues and bones. We performed emergency irrigation and internal fixation with K-wires, and covered the skin deficit with artificial cutis. On the 11th day after injury, we performed arthrodesis of the ankle joint and free transplantation of an antero-lateral thigh flap. At 5 months after the operation, bone union was achieved and the patient was able to walk without pain using one crutch. For severe open ankle fractures with massive deficits of the bone and cartilage, it is important to stabilize the joint, and arthrodesis of the ankle joint should be considered at an early stage.
