Surgical Management of the Posterior Fibula Fracture Dislocation

Delasotta, Lawrence A.; Hansen, Robert H.; Sands, Andrew K.

doi:10.1177/1071100713494379

Cited by 18 publications

(17 citation statements)

References 9 publications

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“…[3][4][5]10 To minimize the potential complications, such as skin necrosis, osteochondral lesions, ankle stiffness, and even posttraumatic arthritis, a single attempt of manually closed reduction, no-delayed open reduction, and internal fixation for the Bosworth fracture was advised by most researchers. 3,4,7,11 Indisputably, we strongly agree that repeated attempts of closed reduction should be avoided, and the surgery should be performed as early as possible. In addition, the use of CT scan for early diagnosis, the application of two quadricortical lag screws for the fixation of syndesmosis, and the progressive postoperative rehabilitation programs in our study are in good agreement with previous studies 7,16 However, other treatment strategies regarding this case were contrary with previous studies' approaches.…”

Section: Discussionmentioning

confidence: 74%

“…10 However, early recognition of the common radiographic features, such as distal tibiofibular overlap on AP view, distal fibula posterior displacement on the lateral view, and medial joint space widening, is useful to avoid misdiagnosis of Bosworth lesion, although they have potential challenges. 11 Some scholars have reported that about 70% of Bosworth fractures are associated with posterior ankle fractures. Early CT examination is helpful to find Bosworth fractures associated with posterior ankle fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Early CT examination is helpful to find Bosworth fractures associated with posterior ankle fractures. 11 In addition, the morphology of the Bosworth variant is usually changed with age, which is helpful in identifying the Bosworth lesion. Reportedly, the Bosworth fracture dislocation have some known characteristics, including common distal fibular fractures with proximal shaft posterior dislocation, rare intact distal fibular posterior dislocation, posterior distal tibia avulsed fracture, pilon fracture, deltoid ligament rupture, medial malleolus fracture, epiphyseolysis fracture, osteochondral lesions, the interosseous membrane lesions, anterior and posterior tibiofibular ligaments injury, and interposition of tissues in joint space.…”

Section: Discussionmentioning

confidence: 99%

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Ankle arthroscopy–assisted closed reduction in Bosworth fracture dislocation

Zhu

2020

SAGE Open Medical Case Reports

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The Bosworth fracture dislocation is a rare type of ankle fracture and is usually unrecognized on initial radiographs, therefore early open reduction is recommended. This study reports a 51-year-old female with uncommon imaging and clinical features. Preoperative X-ray, computed tomography, and magnetic resonance imaging of the ankle showed posterior detached dislocation of the intact distal fibula, the loose osteochondral fragments located in the tibiotalar joint, and the rupture of the deltoid ligament. Due to the initial infected wound on the severely swollen ankle, delayed arthroscopy-assisted closed reduction and internal fixation, removal of loose bodies, and repair of the deltoid ligament were performed, 19 days after injury. Postoperative imaging, including the X-ray, computed tomography, and magnetic resonance imaging, demonstrated the anatomic reduction of the ankle joint. After 6 months of follow-up, the patient gained a pain-free motion of the ankle with a range of passive 10° dorsiflexion and 40° plantar flexion, and resumed her normal gait and activity. This report indicates that the detached posterior dislocation of the intact distal fibula is a rare variant of the Bosworth fracture dislocation, and suggests that arthroscopy-assisted closed reduction and removal of loose osteochondral fragments in joint space are useful technique for this special type of the Bosworth lesions.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ankle arthroscopy–assisted closed reduction in Bosworth fracture dislocation

Zhu

2020

SAGE Open Medical Case Reports

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“…In conclusion, early diagnosis and reduction of Bosworth fracture-dislocation can signi cantly reduce complications. [19][20][21] Most scholars 2,12,20,21 suggested that early open reduction and internal xation is the rst choice due to the di culty associated with manual reduction. Abbreviations CT = computerized tomography; AOFAS = American Orthopedic Foot and Ankle Society Score Declarations Ethics approval and consent to participate Informed written consent was obtained from the patient for publication of this case report and accompanying images.…”

Section: Emergency Surgerymentioning

confidence: 99%

Bosworth Fracture-dislocation of the Ankle: A Case Report and Literature Review

Wang

Feng

Dai

et al. 2020

Preprint

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Introduction: Bosworth fracture-dislocation is an unusual variant of ankle joint fracture and dislocation, which has a high clinically missed diagnosis rate due to poor visibility on X-ray. At the same time, successful closed manipulations in an ankle joint fracture and dislocation are difficult because of the fibula attachment at the posterolateral ridge of the tibia or at the fractured end of the posterior tibia.Patient concerns: A 56-year-old man visited the hospital for further evaluation of a swollen, deformed right ankle resulting from a tumble 4 hours ago. There were no obvious complications such as skin damage or blood vessel and nerve damage at the time of treatment.Diagnosis: The patient was diagnosed with Bosworth fracture-dislocation according to clinical history and X-ray examination and computed tomography (CT), which indicated posterolateral talus dislocation; the distal end of the proximal fibular fragment was inserted behind the tibia.Interventions and outcomes: The patient initially failed to receive twice manipulative reductions. After the first attempt, roentgenograms and CT scan still showed a dislocated ankle and the proximal end of the fibula fracture was still inserted at the fractured end of the posterior tibia although the sound of the joint mounted into the acetabulum was heard. Then the inferior tibiofibula joint was fully exposed and locked with an inferior tibiofibula screw. Review roentgenograms and CT suggested that the ankle was manipulated successfully, and the broken end achieved perfect alignment, leading to a satisfactory function restoration.Lessons: Early diagnosis and reduction of Bosworth fracture-dislocation is recommended, which can significantly decrease complications. The characteristic clinical manifestations of Bosworth fracture-dislocation are worthy of attention, including extreme external rotation of the ankle and difficulty in reduction. Simultaneously, the axilla sign on mortise roentgenograms, posterior dislocation of the talus on the lateral roentgenogram and fibular position relative to the talus on the external oblique roentgenogram are intrinsically valuable. During the surgery, the floating position can better expose the broken fracture end and allow standard lateral roentgenograms. For the reduction of Bosworth fracture-dislocation, it is important to avoid repeated attempts at closed reduction. Intraoperative reduction of the fibula is the key.

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“…The 3D reconstruction of soft tissues, such as muscles and nerve bundles, using computed tomography (CT) images may offer an enhanced understanding of the relationship of their locations. 16 This technique makes it possible to evaluate the relationship of the nerve to the reference anatomical landmarks by using living subjects without limitation to the number of samples. Therefore, we conducted an in vivo anatomical study to describe the course of the radial nerve at the humeral shaft using a 3D reconstruction technique and CT scan images of living subjects.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional measurement of the course of the radial nerve at the posterior humeral shaft: An in vivo anatomical study

Park

Choi

Kang

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Iatrogenic radial nerve injury caused by surgical exposure of the humerus is a serious complication. We aimed to describe the course of the radial nerve at the posterior humeral shaft using a three-dimensional (3D) reconstruction technique by utilizing computed tomography (CT) images of living subjects. We hypothesized that the course of the radial nerve in the posterior aspect of the humeral shaft would be reliably established using this technique and the measurements would have satisfactory intraobserver/interobserver reliabilities. Methods: This in vivo anatomical study utilized 652 upper extremity CT angiography images from 326 patients. A 3D modeling of the humerus and radial nerve was performed. We evaluated the segment of the radial nerve that lays directly on the posterior aspect of the humeral shaft and measured its proximal point, mid, and distal points. The shortest distances from the olecranon fossa to these points were defined as R1, R2, and R3, respectively. The relationships between these parameters and humeral length (HL) and transcondylar length (TL) were evaluated, and the intraobserver/interobserver reliabilities of these parameters were measured. Results: The HL was 293.6 mm, and TL was 58.64 mm on average. The R1 measured 159.2 (range 127.1–198.2) mm, R2 was 136.6 (105.7–182.5), and R3 was 112.8 (76.8–150.0) mm on average ( p < .001). The intraobserver/interobserver reliabilities ranged from 0.90 to 0.98. Conclusion: The course of the radial nerve at the posterior aspect of the humeral shaft can be reliably established using the 3D reconstruction technique, and all measurements had excellent intraobserver/interobserver reliability.

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Surgical Management of the Posterior Fibula Fracture Dislocation

Abstract: Level of Evidence: Level V, expert opinion.Keywords: Bosworth fracture dislocation, supination external rotation injury, posterolateral approach of ankle, interposition of extensor digitorum and hallucis longus muscle/tendon

Cited by 18 publications

References 9 publications

Ankle arthroscopy–assisted closed reduction in Bosworth fracture dislocation

Ankle arthroscopy–assisted closed reduction in Bosworth fracture dislocation

Bosworth Fracture-dislocation of the Ankle: A Case Report and Literature Review

Three-dimensional measurement of the course of the radial nerve at the posterior humeral shaft: An in vivo anatomical study

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