Open Ankle Injury without Associated Fracture or Dislocation Requiring Surgical Intervention: A Case Report.

Introduction: Bony and ligamentous ankle injuries are some of the most commonly treated injuries by orthopedic surgeons. Open ligamentous ankle injuries without an associated fracture or dislocation are rare and to our knowledge have only sparsely been described in the literature. We present a case and successful treatment of an open lateral ankle injury with capsular rupture and ligamentous damage without fracture or dislocation in a 22-year-old female. Due to the rarity of this injury, there is not a standard treatment protocol.

Case report: A 22-year-old female presented with an open ankle injury while playing volleyball after a sudden varus and inversion force. An X-ray obtained at an outside hospital showed no acute fracture or dislocation of the ankle joint. In the operating room, stress examinations showed a positive anterior drawer and a positive varus stress test. Heavy non-absorbable suture was used to repair the ruptured ligaments with the ankle capsule. Augmentation of the repair was performed with a suture anchor placed in the lateral aspect of the distal fibula with one limb running posterior and distal while the other limb reinforced the repair. Subsequently at 6-months post-operative the patient returned to full weight-bearing and radiographs showed maintenance of ankle alignment with no radiographic or clinical signs of instability.

Conclusion: Open ankle injuries without dislocation or fracture are very rare. Therefore, an ample assessment should always be conducted with an understanding that the extent of the injury may be underestimated via static radiographs. Surgical repair is necessary for treatment and we have described one technique through which treatment of open lateral ligamentous ankle injury is possible.