Ankle fractures are among the most common type of fractures of our musculoskeletal system, and their rate has been constantly increasing over the past decades, not only in the young active patients but also in the elderly ones. The stability of the ankle joint is assured by the configuration of the fibula, tibia and talus, as well as by its complex ligamentous system. The optimal treatment of these fractures follows the basic rules of all joint fractures: it is achieved by restoring the ankle mortise and its stability, in order to prevent pain and the development of secondary arthritis. Stable ankle fractures (e.g., isolated fractures of lateral maleolus) can be satisfactorily treated by closed methods, whereas unstable fractures (e.g., bimaleolar, bilameolar equivalents, trimaleolar) must be treated by open reduction and internal fixation. However, one of the aspects that influence the final outcome of these fractures is the coexistence of soft tissue injuries and osteochondral fractures (particularly of the talus), especially if not detected in the X-ray or intra-operative, which will inevitably degenerate in a posttraumatic arthritis. The authors present in this paper a retrospective study of all patients with ankle fractures treated operatively in a period of ten years (January 1993 and December 2003). It where reviewed 376 clinical processes, with a male patient predominance (57%). The fractures where classified according to the Dannis-Weber Classification, and the following items where evaluated: epidemiology, co-morbidities, surgery timing, hospitalization time, surgical options, surgical follow-up and complications. The final evaluation of the patients included clinical, functional and radiological aspects. The authors concluded that in spite of the surgical treatment being well established and indicated in the unstable fractures, its results are frequently influenced by the epidemiologic cofactors, co-morbidities, injury mechanism, coexistence of soft tissue injuries or osteochondral fractures that many times are not detected.
