Detaillierte Beitrags-Information
| Beitragstitel | The Bosworth-like pilon-fracture: An uncommon case of ankle-fracture dislocation |
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| Beitragscode | P073 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Introduction An ankle-fracture dislocation characterized by the dislocation of the fibula posteriorly to the tibial tubercle is defined as ‘‘Bosworth injury’’. Recent evidence shows that Bosworth injuries are often missed and that the true prevalence has been underestimated. Associated fractures such as a pilon fracture, medial malleolus fracture and posterior malleolus fractures have rarely been reported. Since closed reduction is often impossible to achieve, Bosworth fracture-dislocation require urgent surgery. Method In the current report, we present a rare case of a Bosworth-like pilon-fracture with an associated posterior malleolus fracture and impression of the posteromedial pilon. We present a distinct reduction manoeuver, which might improve closed reduction rates in Bosworth-like fracture patterns. Results A 48-year old male patient was admitted to our emergency department, after he suffered a Weber type C fracture of the fibula with a posterior dislocation of the distal fibula behind the posterolateral tibia and posterior subluxation of the talus, representing a Bosworth-like fracture pattern. After 2 attempts in a peripheral hospital, closed reduction was finally achieved by plantar flexion of the ankle joint, pushing the ankle joint together with the distal fibula posteriorly and then pulling the talus laterally, which permits the fibula to pass behind the postero-lateral part of the tibia and go back in its incisura. After closed reduction, a CT scan revealed an additional fracture of the posterior malleolus together with an impression of the posteromedial pilon, which wasn’t evident on plane radiograph. After the soft tissues had improved sufficiently, operative treatment consisted of open reduction and intern fixation of the posterior malleolus and the pilon as well as stabilization of the syndesmosis. Conclusion The Bosworth fracture is an often missed, complex injury of the ankle joint. If encountered, CT scan should be obtained to assess additional fractures and associated soft tissue injuries and further plan operative treatment. In case of an irreducible ankle fracture dislocation, Bosworth-like injuries should be considered as a potential cause. Although closed reduction is difficult to achieve, success rate might be increased by applying axial traction to the plantar flexed ankle joint and laterally reduce the ankle joint. If closed reduction failed, early open reduction and stable internal fixation is the treatment of choice. |