Management of complex ankle fracture: A Ghanaian experience

Abstract

Ankle fractures are among the most common conditions for surgical emergencies in most developing countries including Ghana. Despite the fact that many ankle fractures are uncomplicated, a high proportion may require surgical intervention. Decision-making depends on recognition of the fracture pattern, availability of surgical implants and anaesthetic materials. In resource-limited settings where patients are unable to afford the cost of surgical implants and anaesthetic materials associated with ankle fractures, suggested modification of the open reduction and internal fixation (ORIF) technique have proven to yield satisfactory results. This study retrospectively assessed the effectiveness of the modified ORIF method among Ghanaians living within the Tamale metropolis, a resource-limited setting located in the Northern Region of Ghana. The study reviewed 70 cases of bimalleolus fractures which were either treated using the ORIF based on the Association for the Study of Internal Fixation (ASIF) protocol or a modified version of the ORIF which involves internal fixation of the malleolus without screws. The findings indicate that the modified method is as good as ORIF (based on ASIF protocol) with added benefits such as shorter operation time, reduced risk of anaesthetic complications and cost of operation (anaesthetic agents and orthopaedic implant cost) as well as reduced number of foreign bodies (implants) leading to a lower risk of wound infections. The use of this method however demands that foot and ankle joint must be handled with extreme care so as not to dislocate the tibia malleolus post-operatively.