Temporary External Fixation Across the Ankle After Tibial Nailing

We describe the application of a temporary spanning external fixation device across the ankle in conjunction with intramedullary tibial nailing. This technique can be useful in selected patients with open fractures associated with severe soft-tissue trauma, skin grafts, or muscle flaps. The external fixator allows for wound access and keeps the foot and ankle in a neutral position preventing equinus. A brief period of rigid ankle immobilization is beneficial in preventing muscle motion and sheer stresses on flaps and skin grafts. The external fixator is removed at 3 to 6 weeks once the soft tissues have healed.