One hundred and fifty patients with a displaced fracture of the ankle
caused by external rotation-abduction forces were treated by open reduction
and rigid internal fixation. After an average follow-up of three and
one-half years, the results were satisfactory in 90 per cent. Less
satisfactory results were noted in the more severely injured ankles. We
found that the ruptured deltoid ligament did not need to be repaired if the
lateral side was anatomically and rigidly fixed; in the Maisonneuve
fracture, restoration of the fibular length was as important as
stabilization of the fracture; with the use of the suprasyndesmotic screw,
walking was permissible with the screw in situ; conforming the plate to the
bend of the lateral malleolus was essential; and as much as two millimeters
of lateral residual displacement of the lateral and medial malleoli was
compatible with a satisfactory result, as was a similar displacement of the
talus provided there was anatomical restoration of the lateral side.