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  • Title: High-energy transsyndesmotic ankle fracture dislocation--the "Logsplitter" injury.
    Author: Bible JE, Sivasubramaniam PG, Jahangir AA, Evans JM, Mir HR.
    Journal: J Orthop Trauma; 2014 Apr; 28(4):200-4. PubMed ID: 24177591.
    Abstract:
    OBJECTIVES: To describe and investigate the injury pattern and outcomes of high-energy transsyndesmotic ankle fracture dislocations, or "Logsplitter" injuries, in which the talus is axially wedged into the tibiofibular joint. DESIGN: Prospective Cohort Study. SETTING: Level 1 trauma center. PATIENTS: Prospective evaluation of 23 high-energy transsyndesmotic ankle fracture dislocations (OTA 44-B). INTERVENTION: Operative fixation. MAIN OUTCOME MEASUREMENTS: Radiographs, clinical examination, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, Short Musculoskeletal Function Assessment. RESULTS: Fracture characteristics included 52% open fractures (all medial) and syndesmotic widening of 30.7 ± 11.9 mm. The tibial plafond was involved in 11 (48%) of 23 injuries, with 5 (22%) Chaput, 5 (22%) posterior malleolar fragments, and 6 (26%) with articular impaction. A fibula fracture occurred in all but 1 patient, on average 64.2 ± 40.0 mm above the distal tip. All patients had fixation of their fibular and medial malleolar fractures, 21 of 23 patients had syndesmotic screws, and 8 of 23 had tibial plafond fixation. Anatomic alignment (within <= 2 mm) was obtained in 21 (87%) of 23 injuries. Mean follow-up was 20.6 ± 6.2 months. Sixteen (70%) of 23 patients had radiographic evidence of posttraumatic ankle arthritis. Dorsiflexion and plantarflexion at final follow-up were 6.9 ± 9.6 and 35.6 ± 12.1 degrees, respectively. Complications included a 17% infection and 17% nonunion rate. Average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 67.0 ± 26.8, whereas Short Musculoskeletal Function Assessment Dysfunction index was 32.9 ± 28.6 and Bother index 34.5 ± 29.5. CONCLUSIONS: Transsyndesmotic ankle fracture dislocations, or "Logsplitter" injuries, represent an exceptional pattern of high-energy fractures with significant syndesmotic disruption, potential soft tissue compromise, and possible associated plafond injuries. Careful attention to radiographic findings can identify unique fracture characteristics relative to operative decision-making. Outcomes are comparable to those of high-energy pilon fractures, thereby providing the treating surgeon with prognostic information.
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