Early total care for open lateral ankle dislocation without tearing of tibiofibular sindesmosis: case report

Background: Open dislocation of the ankle not accompanied by rupture of the tibiofibular syndesmosis ligaments is an extremely rare injury. They represent a challenge for surgeon, either in acute or in the late outcomes. Since this is an uncommon injury, there is no standard treatment protocol reported in the literature, which indeed showed that many different treatments have been applied. We report an unusual case of an open lateral dislocation of the ankle joint without tearing of the tibiofibular syndesmosis ligaments accompanied by a complex fracture of the mid-foot. Case Description: A 16-year-old man was admitted to our institution following a motor vehicle accident. The physical examination showed ten centimeters of exposed dislocation of the ankle joint, classified as a Gustilo-Anderson 2A. The radiographic examination reported a fibula fracture, classified as a Weber B one, a displaced distal diaphyseal fracture with dislocation of the base of the fifth metatarsal bone, and fracture of the base of the fourth metatarsal bone. The patient was taken to surgery 150 minutes after injury and a manual reduction of the ankle dislocation under amplioscopic control was performed. The fibula fracture was treated with a cannulated screw and the ankle joint was stabilized with the Hoffman II external bridge fixator. The reduction of the dislocation of the fifth metatarsal was treated with two 1.8 mm K wires, which were fixed on the cuboid bone, and a definitive percutaneous synthesis with intramedullary K wire of the fracture of the fifth metatarsal bone was gained. A follow-up clinical and radiological examination six months after trauma showed a fully resumed daily living and sports activities. Conclusions: An early total care treatment should be considered a good option that allows for mechanical stability and good mobility of the ankle joint.