Open reduction internal fixation

Wide exposure for articular reduction

Disrupts tenuous soft-tissue envelope

Early motion of ankle joint

Multi-stage treatment necessary

Temporary external fixation has decreased complications

Subcutaneous implants

Rigid cross-ankle external fixation

Minimal disruption of zone of injury

Rigidly immobilizes ankle

External fixation of same side of joint

Allows motion at the ankle

Cannot be used for all fractures

Avoids large plates to stabilize metaphysis

Disrupts zone of injury

Technically demanding

Articlated cross-ankle external fixation

Allows motion at the ankle (limited)

Hard to align axis of hinge with axis of ankle joint

Technically easier to apply fixator

Value of motion through an articulated hinge is not proven

Minimal disruption of zone of injury