INTRODUCTION: No comprehensive treatise on the early history of fractures of posterior malleolus (PM) has yet been published, and many substantial discoveries have fallen into oblivion-particularly if not having been published in English originally. MATERIALS AND METHODS: Literature search was performed in original publications and historical sources. RESULTS: Early history of PM fractures from their first description up to the beginnings of their operative treatment may be divided into three basic periods, covering the era between 1828 and 1940. In the pre-radiological period (1828-1895), description of PM injuries was based merely on the autopsy findings in deceased patients. The first mentions of this injury were published by the British authors. In the radiologic period (1899-1916), the x-ray examination started a revolution also in diagnostics of ankle fractures, with the first radiographs performed as early as in 1899. Radiographic examination had subsequently become an integral part of the diagnostics of these injuries and initiated a number of significant studies of PM fractures. The first detailed mention of a PM injury may be found in the French and German literature. The period of early operative treatment (1918-1940), i.e., open reduction and internal fixation of PM, was started by the younger post-WWI generation, primarily the French surgeons, represented by Gaston Picot. His operative technique and the first six cases treated operatively between 1918 and 1921 were described in 1921 by Edouard Huc. Picot himself published his technique in great detail in 1923. CONCLUSION: The early history of diagnostics and treatment of PM fractures witnesses the remarkable body of knowledge gathered about that topic by numerous visionary surgeons predominantly French and German surgeons immediately before and after World War I. They substantially contributed to the radiological examination and operative treatment of this injury.

• Keywords
• Ankle fractures, French literature, History, Internal fixation, Posterior malleolus,
• MeSH
• History, 19th Century MeSH
• History, 20th Century MeSH
• Ankle Fractures * history   surgery   diagnosis   MeSH
• Humans MeSH
• Radiography methods   MeSH
• Fracture Fixation, Internal history   methods   MeSH
• Check Tag
• History, 19th Century MeSH
• History, 20th Century MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Historical Article MeSH
• Review MeSH

Bosworth fracture (BF) is a special type of locked ankle fracture-dislocation, characterized by displacement of a fragment of the fractured fibula from the fibular notch behind the posterior surface of the distal tibia. BF is a complex injury affecting multiple structures of the ankle joint, which is still frequently misjudged even today, potentially leading to severe complications. CT examination, including 3D reconstructions, should be the diagnostic standard in BF, as it provides a complete picture of the fracture pathoanatomy, most prominently the morphology of the frequently associated posterior malleolar fracture. BF requires early reduction of the displaced fibular fragment without repeated attempts on closed reduction. Non-operative treatment of BF almost always fails. The standard treatment procedure is early open reduction internal fixation. Due to the relative severity and paucity of the injury, BF seems to be particularly prone to soft tissue complications, including compartment syndrome. The results of operative treatment are mixed. Many studies report persistent pain even after a short time interval, with limitations of the range of motion or even stiffness of the ankle joint, and development of degenerative changes. Larger studies with long-term results are still missing.

• Keywords
• Ankle fracture, Bosworth fracture, compartment syndrome, posterior malleolus fracture,
• Publication type
• Journal Article MeSH
• Review MeSH

INTRODUCTION: Complex ankle fractures frequently include the posterior malleolus (PM). Despite advances in diagnostic and treatment strategies, PM fracture involvement still predisposes to worse outcomes. While not incorporated into the most common PM fracture classifications, the presence of an intercalary fragment (ICF) complicates treatment. This study aims to describe the incidence, morphology, and location of ICFs in PM fractures. MATERIALS AND METHODS: A total of 135 patients with a mean age of 54.4 (SD ± 18.9) years and PM fractures were analyzed for the presence of an ICF. Patients with an ICF were compared to those without in terms of age, gender, and treatment received. Characteristics of the ICFs in terms of location and size were assessed. Furthermore, the presence of an ICF in relation to the PM fracture classification according to Haraguchi et al., Bartoníček/Rammelt et al., and Mason et al. was investigated. RESULTS: ICFs presented in 55 (41%) of the 135 patients. Patients with an ICF were younger, and the PM was more often operatively treated when compared to patients without an ICF. A posterolateral approach was used significantly more often in patients with an ICF. Almost all ICFs were found in the posterolateral (58%) and posterocentral (35%) regions. The majority of fragments were found in Bartoníček/Rammelt type 2 fractures, the most common fracture type. Bartoníček/Rammelt type 3 fractures had the highest relative frequency of ICFs. CONCLUSION: ICFs are frequently found in PM fractures; however, they are not incorporated into any of the common classifications. They are generally found in younger patients and associated with more complex PM fractures. As they can complicate reduction of the main fragment and may require direct exposure to restore joint congruency, ICFs should be considered in PM fracture classifications. Due to their location, the majority of ICFs are able to be accessed using a posterolateral approach.

• Keywords
• Ankle fracture, Bartoníček/Rammelt, Intercalary fragment, Posterior malleolar fracture,
• MeSH
• Ankle Fractures * diagnostic imaging   surgery   MeSH
• Incidence MeSH
• Middle Aged MeSH
• Humans MeSH
• Tomography, X-Ray Computed MeSH
• Retrospective Studies MeSH
• Tibia MeSH
• Fracture Fixation, Internal MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH

PURPOSE: During study of anatomy of a fractured posterior malleolus of the ankle on CT scans, the authors noticed a prominent crest on the lateral malleolus, which they termed the lateral malleolar crest (LMC). As, in their view, LMC is a clinically important structure which was only briefly mentioned by a few authors without an official term, they focused on the anatomy of this structure. MATERIALS AND METHODS: A total of 352 dry fibulae were analyzed and the following parameters recorded: (F) length of the fibula, (LMC) total length of LMC, (A) length of the part of the examined crest from the superior border of the articular facet of the lateral malleolus (AFLM) to its most proximal intersection with the midline of the fibula, (B) height of the medial triangular rough surface, and (A/F) A/F ratio. RESULTS: The crest was observed in all specimens. (F) was 346.5 ± 26 mm (95% confidence interval [CI] 344-349), (LMC) was 85.4 ± 11.6 mm (95% CI 84.2-86.6), (A/F) was 25% ± 3% (95% CI 24.7-25.3) in the whole group. (A) was 25.9 ± 6.5 mm (95% CI 24.8-26.8) in the whole group, (B) was 34.9 ± 4.7 mm (95% CI 34.3-35.5) in the whole group, 36 ± 6.1 mm (95% CI 35.1-36.9). CONCLUSION: LMC is an important structure on the lateral malleolus. The knowledge of its anatomy is essential for placement of syndesmotic screws or/and the fibular plate.

• Keywords
• Anatomy, Ankle fracture, Distal fibula, Fibular notch, Lateral malleolus, Syndesmotic screw,
• MeSH
• Fibula * diagnostic imaging   anatomy & histology   MeSH
• Ankle Fractures * diagnostic imaging   surgery   MeSH
• Ankle Joint diagnostic imaging   surgery   anatomy & histology   MeSH
• Clinical Relevance MeSH
• Ankle MeSH
• Humans MeSH
• Tibia anatomy & histology   MeSH
• Fracture Fixation, Internal MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

The anterolateral tibial rim with the anterior tibial tubercle (Tubercule de Tillaux-Chaput) serves as an insertion site of the anterior inferior tibiofibular ligament (AITFL). It can also be termed the anterior malleolus or fourth malleolus. Fractures of the anterolateral tibial rim typically result from an external rotation or abduction mechanism of the talus within the ankle mortise. They are frequently overlooked in plain radiographs. Computed tomography (CT) is needed for an exact visualization of the fracture anatomy and treatment planning. A total of three main types can be differentiated: (1) extra-articular avulsion fracture of the AITFL, (2) fracture of the anterolateral distal tibia with involvement of the joint and tibial incisura and (3) impaction fracture of the anterolateral tibial plafond. Surgical fixation of displaced anterolateral distal tibial fractures aims at bone-to-bone stabilization of the anterior syndesmosis, restoration of the tibial incisura for the distal fibula and joint surface. Displaced extra-articular avulsion fractures (type 1) are fixed with a suture anchor or transosseal suture. Larger fragments involving the tibial incisura and plafond (type 2) are mostly fixed with screws. Impression fractures of the anterolateral tibial plafond (type 3) necessitate elevation with restoration of the joint surface, bone grafting of the impaction zone as needed and anterior buttress plating. Only a few studies have reported the treatment results of anterolateral tibial rim fractures in adults. Conservative treatment of dislocated fragments reportedly leads to non-union and malposition of the distal fibula with incongruence of the ankle mortise requiring revision. Impaction fractures (type 3) can lead to secondary avascular necrosis of the anterolateral tibial plafond.

Die laterale Tibiavorderkante mit dem Tuberculum anterius tibiae (Tubercule de Tillaux-Chaput) dient als Ansatz für das Lig. tibiofibulare anterius. Sie kann auch als Malleolus anterior oder vierter Knöchel bezeichnet werden. Frakturen der lateralen Tibiavorderkante entstehen mehrheitlich durch einen Außenrotations- oder Abduktionsmechanismus im oberen Sprunggelenk. Sie werden in Röntgenaufnahmen häufig übersehen. Zur genauen Darstellung der Frakturanatomie und Therapieplanung ist eine CT erforderlich. Es können 3 prinzipielle Typen unterschieden werden: (1) extraartikuläre Avulsionen des vorderen Syndesmosenbandes, (2) Frakturen der anterolateralen distalen Tibia mit Beteiligung von Gelenk und/oder Tibiainzisur, (3) Impaktionsfrakturen des anterolateralen Tibiaplafonds. Die Osteosynthese dislozierter Frakturen der lateralen Tibiavorderkante dient der knöchernen Stabilisierung der vorderen Syndesmose, der Wiederherstellung der Incisura tibiae für die distale Fibula und Gelenkfläche. Dislozierte extraartikuläre Avulsionsfrakturen (Typ 1) werden mithilfe eines Nahtankers oder einer transossären Naht refixiert. Bei größeren Fragmenten mit Beteiligung der Gelenkfläche und Inzisur (Typ 2) erfolgt vorzugsweise eine Schraubenosteosynthese. Impressionsfrakturen des anterolateralen Tibiaplafonds (Typ 3) erfordern die Anhebung mit Wiederherstellung der Gelenkfläche, ggf. eine Spongiosaplastik und eine anteriore Plattenosteosnythese. Es existieren nur wenige Daten über die Behandlungsergebnisse von Tibiavorderkantenfrakturen bei Erwachsenen. Bei konservativer Therapie dislozierter Fragmente werden Pseudarthrosen und revisionspflichtige Fehlstellungen mit Inkongruenz der Knöchelgabel beschrieben. Nach Impaktionsverletzungen (Typ 3) können sekundäre avaskuläre Nekrosen des anterolateralen Tibiaplafonds entstehen.

• Keywords
• Ankle joint, Anterior malleolus, Internal fixation, Tibiofibular syndesmosis, Tillaux fracture,
• MeSH
• Adult MeSH
• Fibula MeSH
• Ankle Fractures * diagnostic imaging   surgery   MeSH
• Tibial Fractures * diagnostic imaging   surgery   MeSH
• Humans MeSH
• Lateral Ligament, Ankle * MeSH
• Tibia MeSH
• Fracture Fixation, Internal MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH