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A systematic review of the "Logsplitter" injury: how much do we know?
Yuan-Wei Zhang1, Yun-Feng Rui1
1Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.; School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.; Orthopaedic Trauma Institute, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.; Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.
Background:
As an emerging proposed type of ankle joint injury, the concept of logsplitter injury is a unified overview of the high-energy ankle fracture and dislocation accompanied by distal tibiofibular syndesmosis separation and displacement. Since the concept of logsplitter injury is still relatively novel, there is no uniform standard for its clinical classification, diagnosis and treatment currently. Thus, we reviewed previous literatures here to provide certain references for its better clinical diagnosis and treatment in future.
Methods:
The available literatures from January 1985 to June 2020 in five medical databases were searched and analyzed. The original articles that evaluated the outcomes of patients treated surgically for the logsplitter injury were included. The detailed data were then extracted from each research, including the researchers, type of study, level of evidence, type of center research, groups, number of patients, gender, age, causes of injury, time from injury to surgery, operative time, intraoperative blood loss, length of follow-up, postoperative complications and clinical outcomes. The overall search procedures were performed by the two independent reviewers.
Results:
Seven pieces of researches (199 patients) were eligible for inclusion. All researches were either retrospective or prospective study, and all but one was single center study. Falling from height ranked first in the causes of injury (52.8%), and followed by the traffic accidents (29.6%). Clinical outcomes were all measured using the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the mean AOFAS score at the final follow-up was 77.9 points.
Conclusions:
None of the definitive consensuses exists on how logsplitter injury should be diagnosed and surgically managed. In light of the novel concept, short presentation time and numerous postoperative complications, the logsplitter injury has not been well understood by most surgeons currently, and its overall situation still needs to be supported by a larger sample size of multicenter research in the future.
