| Objective : With the development of modern industry in China, including construction and transportation business, the morbidity of serious injury resulted from vertical violence damage has been increased for decades, which is higher in areas with labor intensive industry and advanced transportation systems than others, and the lower limbs injury is the most common. “Logsplitter” injury is an unique type of lower limbs injury, and we analysed the cases of “Logsplitter” injuries to investigated the mechanism of injury, clinical treatment and prognosis.Methods : The clinical data of 25 patients who were treated as “Logsplitter”injury at First Affiliated Hospitol of Dalian Medical University, Third People Hospitol of Dalian and Zhoupu Hospitol of Shanghai Pudongxinqu from December 2006 to December 2014 were retrospectively reviewed. With 19 male and 6 female,aged 43.68(21-60)years old. According to the injury reason, the cases were classified as 5 types: 10 hurting injuries,1 sports injuries,3 falling injuries,10 triffical injuries, 1 crushing injuries;12 open injuries,the proportion is 48%,13 close injuries,the proportion is 52%.In open injuries, there were 9 cases of Anderson-Gustilo II and 3 cases of IIIA.According to the AO/OTA, 89% cases were 44 C and the 11% were 44 B. According to the Lauge-Hansen classification, 13 cases were pronation abduction, 9 pronation external rotation, 2 supination external rotation and 1 supination adduction. 24 patients with fibula fractures in people at the same time, the proportion is 96%;Merger of medial malleolus fracture patients a total of 19 people, accounted for 76%.The observations included types and severity of preoperative injury, selection of surgical approach and rates of postoperative complications. The retrospectively study was evidenced with clinical and follow-up imaging data, and objective quantitative analysis by AOFAS scale.Results :The collection of the 27 patients, 2 cases were lost to follow-up, the restof the 25 cases of outpatient follow-up 9 people, telephone follow-up of 16 people.The mean time of follow-up was 29.32 ? 32.14 weeks(13-107). All patients from the pre-hospital review X-ray, requiring patients after discharge after 6 weeks, 3 months, 6months, 1 year outpatient follow-up review of X-ray, and had ankle imaging data. 23 patients with open reduction and internal fixation(ORIF), 2 patients with closed reduction and external fixation(which) + the K-wire was medial malleolus fracture fixation;First phase of the operation of 14 people, second stage surgery 11 people;Fibula fractures in patients who are dealing with fibula is fixed, the application of LCP fixation of fibula 22 people, the K-wire was using fixed 2 people;And to the next leg of 17 people tibiofibular joint screw, 68% of the total;Use one inferior tibiofibular screw 14 people, use 2 inferior tibiofibular screws 3 people;3.5 mm screw utilization rate is higher, at 94.1%, all the three layers into cortex;Merger of medial malleolus fracture reduction and internal fixation in treatment of patients with which uses two hollow nail fixed 17 people, accounting for 89.5%, and the K-wires was used fixed 2 people,accounting for 10.5%;Triangle ligament damage, a total of 14 people, accounted for56%, among them 3 people are completely of the deltoid ligament rupture, 2 with ligament repair, 1 with(with wire anchors) revascularization of the deltoid ligament.Postoperative observation indexes: Limb dorsalis pedis artery can be hit, no cases of poor blood supply;Around the ankle skin healing the average time of 2.26±2.14 weeks;Fractures of the average healing time of 15.34 ± 4.95 weeks;Traumatic arthritis number 18 people, accounting for 72% of the total;Postoperative infection, 2people, the proportion is 8%;Fracture delayed union(more than 4 months are not healing) 1 person, the proportion is 4%;Fracture healing in 0.Postoperative ankle function: back Angle 11.9 ± 2.63 degrees, 10.1 ± 1.91 degrees plantar flexion angles.According to AOFAS ankle- foot after scoring criteria optimal: 90 ~ 90;Good:75 ~ 75;May: 50 ~ 74;Under the poor: 50 points, scored an average of 77.6 points, 25 patients included 5 cases, 18 cases, 2 cases of poor, the vast majority of patients were satisfied with the effect of recovery of ankle joint function.Conclusion : "Logsplitter" injury represents a kind of important and unique verticalviolence, the ankle fracture, dislocation caused by tibiofibular separation and potentially soft tissue injury, at the same time may merge the fornix.We have a unified definition, to such injury and the injury mechanism and treatment principle of a new understanding.:Not all cases are caused by a high-energy violence, middle and low energy such as hurting injuries and sports injuries also can lead to the occurrence of such damage.Such injury treatment principle is: 1.emergency treatment, including manual reduction/plaster external fixation after debridement and reset.2.improve the preoperative preparation,risk assessment, including preoperative surgery anesthesia way choice, the choice of position, etc.3.surgical treatment, fixed fibula or external ankle first, second, reduction and fixation tibial distal "plaford" block and block of talus fractures including front ankles and posterior malleolus, etc.Finally, according to the selective fixed ankle stability under the tibial tibiofibular joint and fix the surrounding soft tissues, including the ligament, etc of the deltoid ligament.4.postoperative rehabilitation, strengthening the toes, 3-4 weeks later go after ankle rehabilitation movement, six weeks after review of the X-ray, step by step load to full load.Judgment according to the results of the follow-up, we have this kind of damage of the clinical treatment effect is ideal,prognosis of functional recovery is relatively satisfactory. |
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