Initial operative treatment consists of irrigation and debridement which is
followed by reduction and stabilization. Because of the complexity of the
fractures and soft-tissue injuries, external fixation is all that one uses
initially. Each case has to be considered on its own merits. However, in each
instance one should use the well-proven principles of treatment.
As elsewhere in the body, application of an external fixator after soft-tissue
care creates the best environment for initial limb management. The external
fixator should be placed outside the zone of injury, with normal anatomy
restored. The foot is best positioned at 90 degrees to the limb with pins in
the tibia, talus, midfoot, or forefoot, as needed in the particular case.