Two-Stage Surgery for the Malleolar Fracture−Dislocation With Severe Soft Tissue Injuries Does Not Affect the Functional Results

Soft tissue injuries associated with malleolar fracture−dislocations may increase postoperative rates of wound complication. Ankle-spanning frame plays a fundamental role in the local damage control orthopedics while gaining time for definitive surgery. The objective of this study was to evaluate the effect of a 2-stage surgery for the unstable malleolar fracture−dislocations with severe soft tissue injuries compared to a 1-stage surgery in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot−ankle and Olerud-Molander ankle scores (OMAS). We analyzed 45 patients who met our study criteria. The patients were divided into 2 groups according to staged surgeries. Demographic data of patients, comorbidities, alcohol and tobacco use, Tscherne soft tissue injury scores, the AOFAS hindfoot−ankle and OMAS, postoperative complications, total hospitalization times, waiting time between stages, and waiting time from admission to surgery times were investigated. There was a statistically significant difference between the groups in terms of the mean total hospitalization times (p =.007), waiting time from admission to surgery (p <.001), gender (p =.005), and Tscherne soft tissue injury scores (p <.001). The mean AOFAS hindfoot−ankle and OMAS of the groups did not differ statistically at a minimum of 12 months of the follow-up period (p =.094 and p =.126, respectively). A 2-stage surgery can be performed safely in the carefully selected patients with the unstable malleolar fracture−dislocations with Tscherne grades 2 and 3 soft tissue injuries, and this surgery does not affect the postoperative AOFAS hindfoot−ankle and OMAS statistically compared to a 1-stage surgery at a minimum of 12 months of the follow-up period. © 2018 the American College of Foot and Ankle Surgeons