title: High-energy transsyndesmotic ankle fracture dislocation--the "Logsplitter" injury.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective Cohort Study.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Prospective evaluation of 23 high-energy transsyndesmotic ankle fracture dislocations (OTA 44-B).
  
  
  METHODS
  Operative fixation.
  
  
  METHODS
  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.
authors.forename: Jesse E
authors.initials: JE
authors.lastname: Bible
authors.forename: Priya G
authors.initials: PG
authors.lastname: Sivasubramaniam
authors.forename: A Alex
authors.initials: AA
authors.lastname: Jahangir
authors.forename: Jason M
authors.initials: JM
authors.lastname: Evans
authors.forename: Hassan R
authors.initials: HR
authors.lastname: Mir
mesh_terms: D000328:Adult; D000368:Aged; D064386:Ankle Fractures; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D055815:Young Adult