PURPOSE: Bosworth fracture-dislocations (BF) with entrapment of a fibular fragment behind the posterior rim of the distal tibia are rare but potentially serious injuries to the ankle. MATERIALS AND METHODS: We analyzed the radiographs of 23 consecutive patients with a mean age of 44 years who were treated for BF. All patients underwent routine radiological examination of the ankle and presence of a BF was confirmed intraoperatively in 22 cases and / or with CT in 15 cases. RESULTS: Tibiofibular overlap intersecting the joint line in the anteroposterior view of the ankle was found in 20 of 23 cases (87%) and persisted in 17 of 18 cases (94%) after unsuccessful closed reduction. Posterior subluxation of the talus in the lateral view was revealed in 21 of 23 cases (91%). Tibio-fibular dissociation, i.e., posterior displacement of the distal fibula relative to the distal tibia in the lateral view was found in 22 of 23 cases (96%). This sign remained positive in all 18 cases with unsuccessful closed reduction. Closed reduction of the talus beneath the distal tibia was associated with an average increase of anterior fibular angulation of 24.5 degrees in case of inadequate closed reduction. CONCLUSIONS: Bosworth fracture represents a rare but still highly variable ankle injury that may lead to misinterpretation of the initial radiographs. Reliable radiological signs are triangular tibiofibular overlap, posterior talar subluxation and tibiofibular dissociation that should prompt CT imaging which is essential for revealing the complex pathoanatomy and planning the surgical approach.

• Keywords
• Ankle fracture-dislocations, Bosworth fracture, CT diagnostics, Posterior malleolus,
• MeSH
• Fracture Dislocation * diagnostic imaging   surgery   MeSH
• Adult MeSH
• Fibula * injuries   diagnostic imaging   MeSH
• Ankle Fractures * diagnostic imaging   surgery   MeSH
• Tibial Fractures * diagnostic imaging   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Tomography, X-Ray Computed MeSH
• Ankle Injuries * diagnostic imaging   surgery   MeSH
• Radiography MeSH
• Reproducibility of Results MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Fracture Fixation, Internal methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article 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

PURPOSE: The aim of this study was to describe the incidence and a complex pathoanatomy of posterior malleolus fractures in a Maisonneuve fracture. METHODS: The study included 100 prospectively collected patients with a complete clinical and radiological documentation of an ankle fracture or fracture-dislocation including a fracture of the proximal quarter of the fibula. RESULTS: A posterior malleolus fracture was identified in 74 patients, and in 27% of these cases it carried more than one quarter of the fibular notch. Displacement of the posterior fragment by more than 2 mm was shown by scans in 72% of cases. Small intercalary fragments were identified in 43% of cases. Fractures of the Tillaux-Chaput tubercle were identified in 20 patients. CONCLUSION: Our study has proved a high rate of posterior malleolus fractures associated with a Maisonneuve fracture, and documented their considerable variability in terms of involvement of the fibular notch, tibiotalar contact area, direction of displacement and frequency of intercalary fragments. Of no less importance is a combination of Tillaux-Chaput fractures with a Maisonneuve fracture.

• Keywords
• Fibular notch, Maisonneuve fracture, Posterior malleolus, Tillaux–Chaput tubercle,
• MeSH
• Fracture Dislocation diagnostic imaging   MeSH
• Adult MeSH
• Fibula injuries   diagnostic imaging   MeSH
• Ankle Fractures * diagnostic imaging   surgery   MeSH
• Incidence MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Tomography, X-Ray Computed MeSH
• Prospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH