Abstrakt
Case description: A 35-year-old man sustained a typical Bosworth fracture-dislocation (BF) with a displacement of the proximal fragment of the fibula behind the posterior surface of the distal tibia, rupture of the deltoid ligament and separation of the posterior malleolus. Attempts at closed reduction failed.
The surgery performed on the day of injury included reduction of the proximal fragment into the fibular notch, internal fixation of the distal fibula with a plate and a lag screw; the deltoid ligament and the posterior fragment of the distal tibia were not revised. Results: The wound healed and the fracture united without complications.
The implants were removed 18 months postoperatively. At the follow-up 13 years after the injury, the patient had a slight limp and reported intermittent pain during weightbearing.
Dorsiflexion and plantar flexion were reduced by little less than half as compared to the uninjured side. Radiograph and CT examination showed union in anatomical position without signs of posttraumatic arthritis.
Overall, the final outcome was assessed as good. Conclusions: BF is a severe injury to the ankle that ist still frequently underestimated.
Its typical features include marked deformation of the ankle, overlap of the distal tibia and fibula on the anteroposterior radiograph, tibiotalar subluxation and tibiofibular dissociation on the lateral radiograph. Computed tomography (CT) is indicated to identify all associated lesions and determine the strategy of operative treatment, the success of which should be verified by postoperative CT in any case of doubt.
Patients should be informed about possible complications and long-term functional deficits. Repeated attempts on closed reduction should be avoided because they regularly fail and only increase the soft tissue strain.