Barber Helena F, Randall Zachary D, Strok Matthew J, Goldfarb Jake H, Yaeger Lauren, Berkes Marschall B
Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Washington University School of Medicine, St. Louis, MO, USA.
Arch Orthop Trauma Surg. 2025 Jan 11;145(1):117. doi: 10.1007/s00402-024-05643-5.
Ankle fractures represent a significant portion of orthopedic injuries, with fracture dislocations tending to have worse outcomes. Logsplitter fractures represent a subset of fracture dislocations in which the talus is axially wedged in the tibiofibular joint. We aim to comprehensively investigate and report on the complications and functional outcomes associated with ankle fracture-dislocations.
Following PRISMA guidelines, a medical librarian conducted a literature search in Embase, Ovid Medline, Scopus, Cochrane Central Register of Controlled Trials, and The Cochrane Database of Systematic Reviews. Studies examining ankle fracture-dislocations and reporting on functional or employment outcomes were included. Excluded were non-English studies, abstracts, conference proceedings, letters, perspective pieces, reviews, editorials, and case reports or series with fewer than five patients. Data on functional outcomes were extracted and reported using descriptive statistics. A comparative analysis of AOFAS scores between Logsplitter and ankle fracture-dislocations was conducted using pooled means and independent t-tests.
A total of 21 studies involving 810 cases of ankle fracture-dislocations were included. The pooled mean AOFAS score across 13 studies was 81.5, indicating "good" outcomes, while Logsplitter injuries had a significantly lower mean score of 75.8 compared to 82.9 for other ankle fracture-dislocations (p = 0.016). Complications included wound infection (7.3%), posttraumatic osteoarthritis (29.2%), nonunion/malunion (12.6%), and malunion. No studies reported on employment outcomes.
Ankle fracture-dislocations are high-energy injuries that affect a younger population compared to non-dislocated ankle fractures. Their functional outcomes resemble those of pilon fractures more than common ankle fractures. Logsplitter injuries are a subset of fracture dislocations that occur in even younger patients, with worse functional outcomes. This information can guide perioperative discussion and expectations for functional recovery. Additional studies are needed to evaluate the impact of these injuries on return to employment.
踝关节骨折在骨科损伤中占很大比例，骨折脱位往往预后较差。劈木机骨折是骨折脱位的一种类型，其中距骨轴向楔入胫腓关节。我们旨在全面调查并报告与踝关节骨折脱位相关的并发症和功能结局。
按照PRISMA指南，医学图书馆员在Embase、Ovid Medline、Scopus、Cochrane对照试验中央注册库和Cochrane系统评价数据库中进行了文献检索。纳入了研究踝关节骨折脱位并报告功能或就业结局的研究。排除非英语研究、摘要、会议论文、信函、观点文章、综述、社论以及患者少于5例的病例报告或系列研究。提取功能结局数据并使用描述性统计进行报告。使用合并均值和独立t检验对劈木机骨折与踝关节骨折脱位的美国足踝外科协会（AOFAS）评分进行比较分析。
共纳入21项涉及810例踝关节骨折脱位的研究。13项研究的合并平均AOFAS评分为81.5，表明结局“良好”，而劈木机骨折损伤的平均评分显著较低，为75.8，其他踝关节骨折脱位的平均评分为82.9（p = 0.016）。并发症包括伤口感染（7.3%）、创伤后骨关节炎（29.2%）、骨不连/畸形愈合（12.6%）以及畸形愈合。没有研究报告就业结局。
踝关节骨折脱位是高能量损伤，与非脱位性踝关节骨折相比，影响年轻人群。它们的功能结局与pilon骨折更相似，而不是常见的踝关节骨折。劈木机骨折损伤是骨折脱位的一种类型，发生在更年轻的患者中，功能结局更差。这些信息可指导围手术期讨论以及对功能恢复的预期。需要进一步研究来评估这些损伤对重返工作的影响。
