Surgical Site Complications in Open Pronation-Abduction Ankle Fracture–Dislocations With Medial Tension Failure Wounds

Objectives: To examine the incidence of surgical site complications associated with pronation-abduction ankle fracture–dislocations with an open medial tension wound. Design: Retrospective case series. Setting: Accredited Level-1 trauma center. Patients/Participants: Forty-eight open pronation-abduction ankle fracture–dislocations with medial tension failure wounds treated at our institution from 2014 to 2016. Intervention: Immediate irrigation and debridement along with surgical stabilization of open ankle fracture–dislocation. Main Outcome Measures: The primary outcome measure was deep surgical site infection. Secondary outcome measures included other surgical site complications and adverse radiographic events. Results: A total of 5 patients (10.4%) developed a deep surgical site infection requiring additional surgical debridement. One of the patients with a deep surgical site infection required a below-knee amputation as a result of sepsis. Adverse radiographic outcomes included 3 fibular nonunions (6.3%), 3 implant failures related to syndesmotic fixations (6.3%), one periimplant fracture (2.1%), and postoperative collapse of the tibial plafond in 3 patients (6.3%). Conclusions: Open pronation-abduction ankle fracture–dislocations with medial tension failure wounds remain a challenging and potentially devastating injury. Our study suggests that with appropriate surgical debridement, early stabilization, and primary wound closure, acceptable outcomes with a relatively low risk of surgical site complications can be achieved. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.