High-energy transsyndesmotic ankle fracture dislocation - The "logsplitter" injury

Jesse Bible, Priya G. Sivasubramaniam, A. Alex Jahangir, Jason M. Evans, Hassan R. Mir

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)200-204
Number of pages5
JournalJournal of orthopaedic trauma
Volume28
Issue number4
DOIs
StatePublished - Jan 1 2014

Fingerprint

Ankle Fractures
Ankle
Wounds and Injuries
Orthopedics
Foot
Joints
Talus
Fibula
Open Fractures
Trauma Centers
Arthritis
Fracture Dislocation
Decision Making
Cohort Studies
Prospective Studies
Infection

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Bible, Jesse ; Sivasubramaniam, Priya G. ; Jahangir, A. Alex ; Evans, Jason M. ; Mir, Hassan R. / High-energy transsyndesmotic ankle fracture dislocation - The "logsplitter" injury. In: Journal of orthopaedic trauma. 2014 ; Vol. 28, No. 4. pp. 200-204.
@article{0370fff37a4a42d482b266a94faeeb9b,
title = "High-energy transsyndesmotic ankle fracture dislocation - The {"}logsplitter{"} injury",
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.",
author = "Jesse Bible and Sivasubramaniam, {Priya G.} and Jahangir, {A. Alex} and Evans, {Jason M.} and Mir, {Hassan R.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/01.bot.0000435605.83497.53",
language = "English (US)",
volume = "28",
pages = "200--204",
journal = "Journal of Orthopaedic Trauma",
issn = "0890-5339",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

High-energy transsyndesmotic ankle fracture dislocation - The "logsplitter" injury. / Bible, Jesse; Sivasubramaniam, Priya G.; Jahangir, A. Alex; Evans, Jason M.; Mir, Hassan R.

In: Journal of orthopaedic trauma, Vol. 28, No. 4, 01.01.2014, p. 200-204.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High-energy transsyndesmotic ankle fracture dislocation - The "logsplitter" injury

AU - Bible, Jesse

AU - Sivasubramaniam, Priya G.

AU - Jahangir, A. Alex

AU - Evans, Jason M.

AU - Mir, Hassan R.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84897434412&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84897434412&partnerID=8YFLogxK

U2 - 10.1097/01.bot.0000435605.83497.53

DO - 10.1097/01.bot.0000435605.83497.53

M3 - Article

C2 - 24177591

AN - SCOPUS:84897434412

VL - 28

SP - 200

EP - 204

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

SN - 0890-5339

IS - 4

ER -