Background: Clinical management of orthopedic hardware infections related to ankle fracture
fixation may present difficult therapeutic dilemmas. Typically, management includes removal
of the hardware, debridement of necrotic tissue, and eventual placement of an alternative
method of stabilization, usually, an external fixator or cast. However, problems arise when
the fracture cannot be managed adequately with an external method. Such is the case with
supination external rotation (SER) fractures, yet maintaining the hardware in the setting of
infection typically is not considered an option.
Methods: Case report and review of pertinent English-language literature.
Results: The patient was a 47-year-old man with diabetes mellitus who sustained a type IV
SER fracture that was treated with plate and screw fixation. Six weeks postoperatively, he
presented with infection of the lateral ankle incision and the hardware. This was treated with
debridement of the wound and dressing changes while leaving the hardware in place. It was
decided to use a free muscle flap in an effort to preserve the ankle for a functional outcome
versus the alternative of a below-knee amputation. With a free rectus abdominis flap, the
lower extremity was preserved, and after four months, the patient was able to walk. One year
postoperatively, the patient was ambulating without difficulty, and the hardware was still in
place.
Conclusions: This report examines the dilemma of SER ankle fractures and how management
strategies must be tailored to the individual situation. In some cases, the hardware must
be considered essential to avoid below-knee amputation.
