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

PURPOSE: The aim of this study was to describe pathoanatomy and to raise awareness of a fracture of the lateral malleolus combined with a high subcapital fracture of the fibula caused by a dislocation mechanism. METHODS: The study comprised 11 patients, 5 men and 6 women, with the mean age of 57 years (range, 21-87), with a "Double Maisonneuve fracture". Individual lesions of ankle structures were described on the basis of radiographs, CT, and intraoperative findings. RESULTS: The distal fibular fracture was classified as Weber type B in 1 case and Weber type C in 10 cases. The proximal fibular fracture was described as a subcapital oblique spiral fracture with metadiaphyseal involvement in nine cases and a high short oblique fracture with fibular head involvement in two cases. Injury to the deltoid ligament was revealed in six cases; a bicollicular fracture of the medial malleolus was found in five patients. Posterior malleolar fractures were classified as type 1 in eight cases and type 2 in three cases. Avulsion of the Chaput tubercle was detected in four cases. Injury to the interosseous tibiofibular ligament was assessed in nine patients. CONCLUSION: Double Maisonneuve fracture is a rare but probably underreported injury that must be taken into consideration during examination, as it may be easily overlooked. The essential part of diagnosis is a careful clinical examination and radiological assessment of the lower leg with additional CT examination of the ankle.

• Keywords
• Ankle fractures, Anterior malleolus, Maisonneuve fracture, Posterior malleolus, Tibiofibular syndesmosis, Trimalleolar fractures,
• MeSH
• Fibula diagnostic imaging   MeSH
• Ankle Fractures * diagnostic imaging   surgery   MeSH
• Ankle Joint pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Fractures, Multiple * MeSH
• Ankle Injuries * diagnostic imaging   surgery   MeSH
• Tibia injuries   MeSH
• Fracture Fixation, Internal MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female 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