The Journal of bone and joint surgery. American volume
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Sixty-two Type-III open fractures of the tibial shaft are reported on. Eleven were Type IIIA, and three of them had non-union while none were associated with deep infection or required secondary amputation. ⋯ Unfortunately, of the nine Type-IIIC injuries, seven ultimately required secondary amputation, from two days to sixty-three months after the initial injury, because of pain, sepsis, non-union, or failure of the vascular repair. Only two patients who had a Type-IIIC fracture have avoided amputation to date, and their results were poor.
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Laterally comminuted fracture-dislocations of the ankle are highly unstable injuries in which anatomical reduction of the talus and restoration of fibular length and rotation are difficult. To our knowledge, no descriptions of the fracture pattern of these injuries and the surgical technique for treating them are available, and surgical results with this fracture have been disappointing. Discontinuity of the fibula as a result of comminution makes accurate assessment of fibular length and rotation impossible if the fibula is reduced first. ⋯ The fibular malleolus is then anatomically positioned in the lateral articular facet of the talus and fixed in this position. The osseous discontinuity of the fibula is grafted with bone. Clinical and radiographic results of the technique were highly satisfactory after a mean length of follow-up of thirty-four months.