Use of emergency room external fixator in provisional reduction of posterior malleolar fractures

Closed reduction is an important initial step in managing ankle fractures. Although the majority of ankle fractures can be managed with closed reduction, the posterior malleolar fracture is often unstable. Posterior malleolar fractures may result in persistent posterior ankle dislocation with compromise of the soft tissue surrounding the joint. Persistent dislocation is best treated with urgent open reduction and fixation to protect the cartilage and surrounding soft tissues and to allow for ease of reduction at the time of surgery. We describe a technique for placing an emergency room external fixator for provisional reduction of the unstable posterior malleolar fracture. This technique allows for early reduction of unstable posterior malleolar fractures and avoids the need for urgent operative reduction.