A systematic review of the "Logsplitter" injury: how much do we know?

Effects of foot intrinsic muscle dynamic stretching on balance, gait parameters, and dynamic gait index in patients with chronic stroke: A randomized controlled study (CONSORT)

BACKGROUND

Foot intrinsic muscle dynamic stretching intervention can correct balance ability and induce a change in spatiotemporal parameters gait ability. Our objective was to compare the effects of a 4-week program of foot intrinsic muscle dynamic stretching with those of lunge exercise on static balance, dynamic balance, gait parameters (velocity, cadence, step length, and stride length), and the dynamic gait index (DGI) in chronic stroke patients.

METHODS

The participants were randomized to either the foot intrinsic muscle dynamic stretching (n = 10) or standard lunge exercise (n = 10) groups. Both groups performed 3 sets of lunge exercises 5 times per week for 4 weeks. Each set comprised 10 repetitions. Static and dynamic balance, gait parameters, and the DGI were measured after 4 weeks of training.

RESULTS

After 4 weeks of training, the foot intrinsic muscle dynamic stretching group showed significant improvement in all outcome measures compared with the baseline (P < .05). Furthermore, timed up and go, velocity, step length, stride length, and DGI showed greater improvement in the foot intrinsic muscle dynamic stretching group than in the standard lunge exercise group (P < .05).

CONCLUSIONS

This study demonstrated that foot intrinsic muscle dynamic stretching training improved dynamic balance, velocity, step lengths, stride length, and DGI in patients with chronic stroke.

A case report on the successful treatment of a specific type of open ankle fracture-dislocation called logsplitter injury

This case report presents the successful management of a rare and complex open ankle fracture-dislocation known as a 'Logsplitter Injury', resulting from a high-energy traumatic event. The patient, a Chinese male in his early 20 s, sustained a severe left lower limb injury in a traffic accident. Initial clinical assessments revealed significant swelling, pain and an open fracture with extensive soft tissue damage. The patient underwent an emergency surgical intervention, involving meticulous wound debridement, internal fixation and reconstruction of the lower tibiofibular union, was performed. The use of vancomycin-loaded polymethylmethacrylate bone cement and negative pressure wound therapy contributed to the favourable outcome. Post-operative care encompassed comprehensive analgesia and infection prevention measures, resulting in substantial ankle function recovery. Follow-up assessments revealed healed fractures and excellent joint alignment, with the patient attaining an AOFAS score of 85, indicative of good functional recovery. This case underscores the effectiveness of individualised treatment plans and multidisciplinary teamwork in managing such challenging injuries, offering valuable clinical insights and highlighting the potential for successful outcomes with timely and precise surgical interventions.

The efficacy and safety of platelet-rich plasma in the tendon-exposed wounds: a preliminary study

Objective

Currently, among wounds with large skin tissue defects caused by various reasons, the treatment of refractory wounds is still a major clinical problem. This study is aimed to preliminarily assess the therapeutic potentials of platelet-rich plasma (PRP) in refractory wounds with exposed tendons, as well as corresponding efficacy and safety.

Methods

A total of 12 patients (5 males and 7 females) with refractory wounds and exposed tendons who were admitted to our hospital from June 2018 to December 2020 were included in this study. After the preparation of PRP, the included patients underwent the PRP injection after the debridement of wounds, and the efficacy and prognosis were assessed by the same group of senior surgeons.

Results

The average age of included patients was 42.7 ± 12.9 years, and the causes of injury included traffic accidents (3 cases), contusion (2 cases), burns (2 cases), diabetes complications (4 cases), and melanoma complications (1 cases). The average healing time was 23.0 ± 5.0 days, and the mean size of the wound was 3.1 × 5.1 cm². During the whole treatment process, Vancouver Scar Scale (VSS) decreased from 7.4 ± 1.6 before PRP treatment to 3.6 ± 0.9 after treatment (P < 0.001), Manchester Scar Scale (MSS) decreased from 12.3 ± 4.5 before PRP treatment to 5.4 ± 1.2 after treatment (P < 0.001), and no redness and swelling were observed around wounds, the size and degree of wounds gradually reduced, the coverage rate of granulation tissue was acceptable, overall quality of scar was relatively good, skin sensitivity around wounds was normal, there was no local wounds secretion, and postoperative patient's satisfaction was relatively good during follow-up.

Conclusions

Our study has preliminarily indicated that PRP can promote the wounds healing, reduce the inflammation around wounds, and improve the granulation tissue and angiogenesis, thereby effectively polishing up the safety and efficacy.

3D Mapping of the Lateral Malleolus Fractures for Predicting Syndesmotic Injuries in Supination External Rotation Type Ankle Fractures

Supination external rotation (SER) type ankle fracture is the most common ankle fracture in the Lauge-Hansen classification and is often accompanied with syndesmotic injury. However, the mechanism of this injury is indistinct and a suggestive role can be given by preoperative imaging. This study was to preoperatively predict whether SER type ankle fractures are accompanied with syndesmotic injuries by the means of lateral malleolus fracture mapping. One hundred and forty-eight patients diagnosed with SER type ankle fractures were retrospectively enrolled in this study. The baseline data were collected and computed tomography data were reconstructed in 3-dimensional (3D) model. Patients were divided into stable and unstable groups according to intraoperative Cotton test and whether the inferior tibiofibular screw was placed. All fracture lines were superimposed on the ankle template to create a fracture map, and the data on the fracture map were further measured. Logistic regression was conducted to identify relevant factors and the cutoff values were given using receiver operating characteristic curves. Forty-one patients were enrolled in the unstable group and 107 patients were enrolled in the stable group. The lateral malleolus fracture lines of the unstable group were higher and steeper than that in the stable group on lateral and posterior views. The fracture height of the posterior cortex and peak height were the significant contributing factors, and the cut-off values of posterior cortex, peak height and inclination angle were 40.35 mm (sensitivity: 78%, specificity: 82%), 55.34 mm (sensitivity: 85%, specificity: 70%) and 55.6° (sensitivity: 66%, specificity: 86%), respectively. In general, when the fracture lines of the lateral malleolus were high and steep, it was usually indicative of a syndesmotic injury and can be predicted by the preoperative 3D reconstruction of fracture height of posterior cortex, peak height and inclination angle. If the cut-off values of these indicators are exceeded, the syndesmotic injuries may be presented and need to be verified in the intraoperative Cotton test to decide whether to insert an inferior tibiofibular screw.

Treatment and outcome of a patient with low-energy 'Logsplitter' injury

The low-energy ‘Logsplitter’ fracture, caused by a sprain or fall, is characterized by an intact or slightly separated inferior tibiofibular joint. Compared with the high-energy ‘Logsplitter’ fracture, this atypical subtype is rarely seen and is easily missed. Here, the case of a 33-year-old male patient with a fractured right ankle as a result of a sprain during walking is reported. The patient initially received routine surgical treatment comprising internal fixation of the fibular, medial and posterior malleoli. Unexpectedly, post-surgery imaging examinations revealed that the medial clear space of the right ankle had widened to 6 mm, due to incomplete reduction of the lateral malleolus, shortening and rotation of the fibula, and an unreduced avulsion fracture block of the anterior malleolus. A revision surgery was then performed to anatomically reduce and fix the lateral malleolus, as well as the anterior malleolus avulsion fracture. During 5 months following surgery, the patient achieved good fracture union and functional restoration of the right ankle. For this rare injury, the present case demonstrates that complete restoration of the fracture is required to achieve good clinical efficacy.

A systematic review of ankle fracture-dislocations: Recent update and future prospects

BACKGROUND

Ankle fracture-dislocations are one of the most severe types of ankle injuries. Compared to the simple ankle fractures, ankle fracture-dislocations are usually more severely traumatized and can cause worse functional outcomes. The purpose of this study was to review the previous literatures to understand the anatomy, mechanisms, treatment, and functional outcomes associated with ankle fracture-dislocations.

METHODS

The available literatures from January 1985 to December 2021 in three main medical databases were searched and analyzed. The detailed information was extracted for each article, such as researchers, age, gender, groups, type of study, type of center research, level of evidence, significant findings, study aim, cause of injury, time from injury to surgery, type of fracture, direction of dislocation, follow-up, postoperative complications and functional evaluation scores.

RESULTS

A total of 15 studies (1,089 patients) met the inclusion criteria. Only one study was a prospective randomized trial. The top-ranked cause of injury was high-energy injury (21.3%). Moreover, the most frequent type of fracture in ankle dislocations was supination-external rotation (SER) ankle fracture (43.8%), while the most common directions of dislocation were lateral (50%) and posterior (38.9%).

CONCLUSIONS

Collectively, most ankle fracture-dislocations are caused by high-energy injuries and usually have poor functional outcomes. The mechanism of injury can be dissected by the ankle anatomy and Lauge-Hansen's classification. The treatment of ankle fracture-dislocations still requires more detailed and rational solutions due to the urgency of occurrence, the severity of injury, and the postoperative complications.