Hexapod external fixation for treating joint displacement and soft tissue contractures in mistreated ankle fractures: a case series.

Background: In displaced distal tibia articular fractures, the thin soft tissue envelope dictates time dependent precise realignment and stabilization in order to avoid pressure complications induced by displaced bone segments on overlying structures, consenting a safer approach to definitive surgery. Damage control techniques have been conceived to undertake this task. Nevertheless, problems can arise in cases not achieving initial adequate reduction or losing reduction in the meantime before a delayed surgery. Otherwise, complex distal tibia fractures treated with circular external fixation (CEF) can drift out of alignment during treatment due to unsatisfactory stabilization. Methods: In three cases where soft tissue contractures and skin compromise posed significant challenges to acute reduction and osteosynthesis, hexapod external fixation was used to progressively achieve precise reduction, allowing resolution of contractures and associated skin ulcers. Definitive internal fixation was subsequently performed. Results: At the end of treatment, all three patients were able to walk with full weight bearing, reporting mild or no symptoms, and regained a functional ankle range of motion. Conclusion: This case series emphasizes the importance of adaptive management strategies in trauma cases with soft tissue complications, highlighting the potential benefits of using circular external fixation with hexapod systems.