High-Energy Transsyndesmotic Ankle Fracture Dislocation—Injury Characteristics, Radiographic Outcomes, and Factors Affecting the Rate of Posttraumatic Arthritis in Logsplitter Injuries

Abstract

Objectives:To investigate patient demographics, injury characteristics, radiographic outcomes, and identify risk factors for developing posttraumatic arthritis in high-energy transsyndesmotic ankle fracture dislocations or “logsplitter” injuries.Design:Retrospective cohort study.Setting:Academic level one trauma center.Patients/Participants:Twenty-seven adult patients with logsplitter injuries.Intervention:All patients were treated with open reduction internal fixation, with possible addition of syndesmosis screw(s) and deltoid repair.Main Outcome Measurements:The rate of posttraumatic arthritis at one year along with rate and reasons for reoperation.Results:Twenty-seven patients were included with a mean follow-up of 14.5 ± 12.5 months. At one-year postoperative, 14 of the 20 patients (70%) demonstrated posttraumatic arthritis. Two patients (7.4%) went onto fusion. The reoperation rate was 51.9%. There was no significant difference in the arthritis rate with the number of syndesmosis screws used, quality of reduction, or addition of deltoid repair.Conclusions:The logsplitter injury is one with devastating outcomes and high rates of arthritis; it should be considered separately from conventional ankle fractures. The role of deltoid repair remains unclear. Further study of this injury pattern is required.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Pediatric Maisonneuve and Tillaux Fractures with Lateral Ankle Dislocation: A Pediatric “Logsplitter” Injury

“…Although our patient did well after surgery, in the adult population, the incidence of post-traumatic ankle arthritis ranged between 68% and 70%, 20–22 with better outcomes with anatomic reduction of the fractures 21 .…”