Open ankle fractures — where the fracture communicates with the external environment — represent a time-sensitive subset of ankle injuries requiring a structured, sequenced management approach from the moment of presentation.
Open ankle fractures account for approximately 1.5% of all ankle fractures. The breach of soft tissue creates an immediate risk of contamination and infection, and both the wound status and mechanism of injury directly determine the urgency and staging of surgical care.
Management involves urgent wound contamination control and time-sensitive intravenous antibiotic prophylaxis, followed by surgical debridement and definitive fixation with soft tissue coverage — sequenced according to the contamination level and injury pattern.
DOI: 10.1177/1750458920988162
Patients with open fractures, which make up 1.5% of all ankle fractures, should have any gross contaminants removed and their injury photographed.
The fracture site should then be covered with a saline-soaked sterile dressing and wrapped loosely with an occlusive film whilst awaiting debridement surgery.
Intravenous antibiotic prophylaxis should be given as soon as possible, preferably within 1 hour of injury.
Debridement should occur immediately for highly contaminated open fractures, within 12 hours for high-energy open fractures that are not highly contaminated and within 24 hours for all other open fractures.
Fixation and definitive soft tissue cover should be performed at the same time where possible, or if not possible, within 72 hours of injury.
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