Surgical effectiveness of ankle "Logsplitter" injury plus avulsion fractures without tibiofibular joint screwing

Objective To explore the surgical efficacy of trans-syndesmotic ankle fracture dislocation (the "Logsplitter" injury) plus the Tillaux-Chaput fracture/the Wagstaffe-Lefort fracture and the Volkmann fracture without tibiofibular joint screwing. Methods Between January 2015 and December 2018, 16 adult patients with the "Logsplitter" injury plus avulsion fractures were treated by open reduction and internal fixation at Department of Orthopaedics, The Sixth Affiliated Hospital, Xinjiang Medical University. They were 11 males and 5 females with an average age of 36.4 years (range, from 27 to 56 years). There were 2 open fractures (one type Ⅱ and one type ⅢA by the Anderson-Gustilo classification) and 14 closed ones; all fractures were type 44-C by the AO/OTA classification; according to the Lauge-Hansen classification, there were 9 cases of pronation-abduction rotation, 3 cases of pronation-external rotation and 4 cases of supination-external rotation. The fibular fractures were treated through a single lateral approach followed by plate fixation. The Volkmann fractures were fixed with screws and the Tillaux-Chaput fractures/the Wagstaffe-Lefort fractures with screws or Kirschner wires. The ankle functions were assessed postoperatively using the ankle-hindfoot rating system of the American Orthopaedic Foot and Ankle Society (AOFAS), and the dysfunction index and bother index of Short Musculoskeletal Function Assessment (SMFA). Results All the patients were followed up for 8 to 27 months (average, 21.3 months). X-ray films showed complete fracture healing in all cases after 12 to 18 weeks postoperatively (mean, 14.8 weeks). At the last follow up, 13 patients walked normally and 2 with mild discomfort. Their AOFAS scores averaged 96.3 (range, from 86 to 100), giving 12 excellent, 3 good and one poor cases; their SMFA dysfunction index was 15.9 (range, from 8 to 17)and SMFA bother index 6.5 (range, from 3 to 9)at the last follow-up. Conclusions In the treatment of trans-syndesmotic ankle fracture dislocation - the "Logsplitter" injury, open reduction and internal fixation of the Tillaux-Chaput fracture/the Wagstaffe-Lefort fracture and the Volkmann fracture to reconstruct the lower tibiofibular horizontal stable "ring" , without tibiofibular joint screwing, can obtain satisfactory clinical results. Key words: Ankle joint; Fractures; Fracture fixation, internal; Logsplitter injury; Distal tibiofibular syndesmosis