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

OBJECTIVES To investigate patient demographics, injury characteristics, radiographic outcomes, and identify risk factors for developing post-traumatic 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 Rate of post-traumatic arthritis at one year along with rate and reasons for reoperation. RESULTS Twenty-seven patients were included with mean follow up of 14.5+/-12.5 months. At one year postoperative, 14/20 patients (70%) demonstrated posttraumatic arthritis. Two patients (7.4%) went onto fusion. Reoperation rate was 51.9%. There was no significant difference in arthritis rate with the number of syndesmosis screws used, quality of reduction, or the 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 III. See Instructions for Authors for a complete description of levels of evidence.