General considerations
In a polytrauma patient it takes too much time to reconstruct the ankle joint anatomically.
However, joint instability increases soft-tissue insult and should be eliminated. In patients with excessive swelling, or severe soft-tissue injuries early ORIF could cause further damage to the soft tissues.
With an external fixator, the joint can be reduced and provisionally stabilized in an adequate position, while awaiting decrease of swelling. Later anatomical reconstruction by ORIF becomes possible.

Further indications

  • Displaced, unstable fractures 
  • Open fractures with severe soft-tissue injury


  • Patient not fit for surgery
  • Low demand patient 
  • Peripheral vascular diseases or poor soft tissues


  • Stabilization of the joint
  • Early functional recovery 


  • Risk of pin-track infection
  • Risk of soft-tissue breakdown
  • Failure to control large posterior fragment