Effectiveness comparison of open reduction and internal fixation for open and closed ankle Logsplitter fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

REN Yi ^1,2 , WU Shizhou ^1,2 , DENG Wei ³ , SONG Runlai ³ , DONG Hongxian ³ , LI Yaxing ³ , CHEN Yu ³ , LIU Yunjie ⁴ , HUANG Fuguo ³ ,  ZHANG Hui ^2,3

1. West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Disaster Medical Center, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
3. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
4. West China School of Public Health, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

ZHANG Hui, Email: caesarzh@163.com

Keywords：

Logsplitter fracture; ankle fracture; open reduction and internal fixation; distal tibiofibular syndesmosis

DOI：

10.7507/1002-1892.201712073

Video：

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ObjectiveTo investigate the effectiveness of open reduction and internal fixation on high-energy ankle Logsplitter injuries (a kind of transsyndesmotic ankle fracture dislocation), and compare the prognosis between open and closed Logsplitter fracture.MethodsThe clinical data of 36 Logsplitter fractures treated with open reduction and internal fixation between April 2011 and May 2016 were retrospectively analyzed. Among them, 15 cases were open fracture and dislocation (open group) and 21 cases were closed fracture and dislocation (closed group). There was no significant difference between the two groups in gender, age, combined injury, injury to hospital admission time (P>0.05), with comparability. The wound healing, ankle mobility recovery, complications, and fracture healing were observed after operation. The ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsBoth groups were followed up 12-29 months (mean, 19 months). There was no significant difference in the follow-up time between the open group and the closed group (t=1.169, P=0.251). In the open group, there were 3 cases of postoperative infection, 3 cases of nonunion, and 5 cases of post-traumatic osteoarthritis; each mentioned complications had 1 case in the closed group; there was no significant difference in complications incidence between the two groups (P=0.41) except post-traumatic osteoarthritis incidence (P=0.02). At last follow-up, there was no significant difference in AOFAS score between the two groups (t=1.981, P=0.056). According to AOFAS score criterion, the results were good in 10 cases and general in 5 cases in the open group, and good in 13 cases and general in 8 cases in the closed group, showing no significant difference (P=0.796). There was no significant difference in the union duration and ankle flexion, dorsal extension, varus, and valgus motion between the two groups (P>0.05).ConclusionOpen reduction and internal fixation for open or closed Logsplitter fractures can achieve satisfactory results, improve fracture healing rate, effectively reduce the incidence of complications, and improve ankle function.

Citation： REN Yi, WU Shizhou, DENG Wei, SONG Runlai, DONG Hongxian, LI Yaxing, CHEN Yu, LIU Yunjie, HUANG Fuguo, ZHANG Hui. Effectiveness comparison of open reduction and internal fixation for open and closed ankle Logsplitter fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(10): 1302-1307. doi: 10.7507/1002-1892.201712073 Copy

1.	Mandi DM. Ankle fractures. Clin Podiatr Med Surg, 2012, 29(2): 155-186.
2.	Bible JE, Sivasubramaniam PG, Jahangir AA, et al. High-energy transsyndesmotic ankle fracture dislocation—the " Logsplitter” injury. J Orthop Trauma, 2014, 28(4): 200-204.
3.	Leininger RE, Knox L, Comstock RD. Epidemiology of 1.6 million pediatric soccer-related injuries presenting to US emergency departments from 1990 to 2003. Am J Sports Med, 2007, 35(2): 288-293.
4.	Miller AG, Margules A, Raikin SM. Risk factors for wound complications after ankle fracture surgery. J Bone Joint Surg (Am), 2012, 94(22): 2047-2052.
5.	Soohoo NF, Krenek L, Eagan MJ, et al. Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg (Am), 2009, 91(5): 1042-1049.
6.	Amendola A, Williams G, Foster D. Evidence-based approach to treatment of acute traumatic syndesmosis (high ankle) sprains. Sports Med Arthrosc Rev, 2006, 14(4): 232-236.
7.	Wang Z, Tang X, Li S, et al. Treatment and outcome prognosis of patients with high-energy transsyndesmotic ankle fracture dislocation-the " Logsplitter” injury. J Orthop Surg Res, 2017, 12(1): 3.
8.	Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg (Am), 1976, 58(4): 453-458.
9.	Naal FD, Impellizzeri FM, Rippstein PF. Which are the most frequently used outcome instruments in studies on total ankle arthroplasty? Clin Orthop Relat Res, 2010, 468(3): 815-826.
10.	Mann G, Nyska M, Hetsroni I, et al. Scoring systems for evaluating ankle function. Foot Ankle Clin, 2006, 11(3): 509-519.
11.	Stinner DJ, Edwards D. Surgical management of musculoskeletal trauma. Surg Clin North Am, 2017, 97(5): 1119-1131.
12.	Gardner MJ, Brodsky A, Briggs SM, et al. Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res, 2006, 447: 165-171.
13.	Hak DJ, Fitzpatrick D, Bishop JA, et al. Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury, 2014, 45(Suppl 2): S3-7.
14.	Dahabreh Z, Calori GM, Kanakaris NK, et al. A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7. Int Orthop, 2009, 33(5): 1407-1414.
15.	Stull J D, Bhat SB, Kane JM, et al. Economic Burden of Inpatient Admission of Ankle Fractures. Foot Ankle Int, 2017, 38(9): 997-1004.
16.	Zalavras CG. Prevention of infection in open fractures. Infect Dis Clin North Am, 2017, 31(2): 339-352.
17.	Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res, 1989, (243): 36-40.
18.	Pollak AN, Jones AL, Castillo RC, et al. The relationship between time to surgical débridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg (Am), 2010, 92(1): 7-15.
19.	Haraguchi N, Armiger RS, Myerson MS, et al. Prediction of three-dimensional contact stress and ligament tension in the ankle during stance determined from computational modeling. Foot Ankle Int, 2009, 30(2): 177-185.
20.	van Zuuren WJ, Schepers T, Beumer A, et al. Acute syndesmotic instability in ankle fractures: A review. Foot Ankle Surg, 2016, 23(3): 135-141.
21.	Fort NM, Aiyer AA, Kaplan JR, et al. Management of acute injuries of the tibiofibular syndesmosis. Eur J Orthop Surg Traumatol, 2017, 27(4): 449-459.
22.	Xu HL, Li X, Zhang DY, et al. A retrospective study of posterior malleolus fractures. Int Orthop, 2012, 36(9): 1929-1936.
23.	Crist BD, Khazzam M, Murtha YM, et al. Pilon fractures: advances in surgical management. J Am Acad Orthop Surg, 2011, 19(10): 612-622.

1. Mandi DM. Ankle fractures. Clin Podiatr Med Surg, 2012, 29(2): 155-186.
2. Bible JE, Sivasubramaniam PG, Jahangir AA, et al. High-energy transsyndesmotic ankle fracture dislocation—the " Logsplitter” injury. J Orthop Trauma, 2014, 28(4): 200-204.
3. Leininger RE, Knox L, Comstock RD. Epidemiology of 1.6 million pediatric soccer-related injuries presenting to US emergency departments from 1990 to 2003. Am J Sports Med, 2007, 35(2): 288-293.
4. Miller AG, Margules A, Raikin SM. Risk factors for wound complications after ankle fracture surgery. J Bone Joint Surg (Am), 2012, 94(22): 2047-2052.
5. Soohoo NF, Krenek L, Eagan MJ, et al. Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg (Am), 2009, 91(5): 1042-1049.
6. Amendola A, Williams G, Foster D. Evidence-based approach to treatment of acute traumatic syndesmosis (high ankle) sprains. Sports Med Arthrosc Rev, 2006, 14(4): 232-236.
7. Wang Z, Tang X, Li S, et al. Treatment and outcome prognosis of patients with high-energy transsyndesmotic ankle fracture dislocation-the " Logsplitter” injury. J Orthop Surg Res, 2017, 12(1): 3.
8. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg (Am), 1976, 58(4): 453-458.
9. Naal FD, Impellizzeri FM, Rippstein PF. Which are the most frequently used outcome instruments in studies on total ankle arthroplasty? Clin Orthop Relat Res, 2010, 468(3): 815-826.
10. Mann G, Nyska M, Hetsroni I, et al. Scoring systems for evaluating ankle function. Foot Ankle Clin, 2006, 11(3): 509-519.
11. Stinner DJ, Edwards D. Surgical management of musculoskeletal trauma. Surg Clin North Am, 2017, 97(5): 1119-1131.
12. Gardner MJ, Brodsky A, Briggs SM, et al. Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res, 2006, 447: 165-171.
13. Hak DJ, Fitzpatrick D, Bishop JA, et al. Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury, 2014, 45(Suppl 2): S3-7.
14. Dahabreh Z, Calori GM, Kanakaris NK, et al. A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7. Int Orthop, 2009, 33(5): 1407-1414.
15. Stull J D, Bhat SB, Kane JM, et al. Economic Burden of Inpatient Admission of Ankle Fractures. Foot Ankle Int, 2017, 38(9): 997-1004.
16. Zalavras CG. Prevention of infection in open fractures. Infect Dis Clin North Am, 2017, 31(2): 339-352.
17. Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res, 1989, (243): 36-40.
18. Pollak AN, Jones AL, Castillo RC, et al. The relationship between time to surgical débridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg (Am), 2010, 92(1): 7-15.
19. Haraguchi N, Armiger RS, Myerson MS, et al. Prediction of three-dimensional contact stress and ligament tension in the ankle during stance determined from computational modeling. Foot Ankle Int, 2009, 30(2): 177-185.
20. van Zuuren WJ, Schepers T, Beumer A, et al. Acute syndesmotic instability in ankle fractures: A review. Foot Ankle Surg, 2016, 23(3): 135-141.
21. Fort NM, Aiyer AA, Kaplan JR, et al. Management of acute injuries of the tibiofibular syndesmosis. Eur J Orthop Surg Traumatol, 2017, 27(4): 449-459.
22. Xu HL, Li X, Zhang DY, et al. A retrospective study of posterior malleolus fractures. Int Orthop, 2012, 36(9): 1929-1936.
23. Crist BD, Khazzam M, Murtha YM, et al. Pilon fractures: advances in surgical management. J Am Acad Orthop Surg, 2011, 19(10): 612-622.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison of open reduction and internal fixation for open and closed ankle Logsplitter fractures

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