This review of 479 fractures of the ankle, comprising 139 recent fractures and 340 old fractures, emphasizes once more the importance of correct reduction to secure a sound useful ankle. Likewise it demonstrates that failure to effect perfect reduction through delay or failure to recognize the lesion inevitably leads to poor results and a high percentage of disability.

The trimalleolar fracture, in particular, with both lateral and posterior displacement of the foot if not reduced, is more likely to produce serious disability than is the bimalleolar type of fracture with only lateral displacement. Posterior displacement of the entire foot causes grave incapacity if uncorrected, and, even with operation later, its evil results are seldom rectified. Unlike the trimalleolar, the old bimalleolar fracture with valgoid deformity can often be successfully corrected by osteotomy if diastasis with injury to the outer border of the tibial pilon is not present.

The injury referred to is produced by diastasis of the tibia and fibula, with resulting rupture of the tibiofibular ligament and perhaps injury to the external margin of the tibia. The normal relation between the astragalus and the weight-bearing surface of the tibia is disrupted and, even with late corrective operation, there is a low percentage of satisfactory results.

We see, therefore, that corrective surgical measures on the improper results from old fractures of the ankle are far less important than early, accurate reduction followed by careful, adequate immobilization, and that the patient's ultimate happiness depends most on the physician who cares for him at the time of his injury.