Department of Surgery of 1st Faculty of Medicine, Charles University and Thomayer Hospital, Videnska 800, Prague 4, 140 00, Czech Republic.
Department of Orthopaedics, First Faculty of Medicine, Charles University and Central Military Hospital, U Vojenské nemocnice 1200, Prague 6, 169 02, Czech Republic.
Injury. 2020 Feb;51(2):537-541. doi: 10.1016/j.injury.2019.10.088. Epub 2019 Oct 31.
Posterior malleolar fractures (PM) have been linked to inferior outcome in malleolar fractures. This study aims to analyze the prevalence and pathoanatomy of PM fractures in Bosworth fracture-dislocations (BF).
MATERIALS & METHODS: Radiographs and computed tomography (CT) scans of 13 patients treated at our institution and 97 cases published between 1947 and 2018, identified in a systematic literature search, were evaluated with respect to the pathoanatomy of BF. In all 13 cases from the present study and in 10 cases from the literature, axial CT scans were performed.
All 13 patients (100%) with BF from the present series and 61 of 97 documented cases (63%) of BF from the literature were associated with a PM fracture. In patients with a complete CT analysis, dislocation of the fibula behind the posterior tibial rim was associated with extraincisural (Bartoníček / Rammelt type 1) PM fractures. Displacement of the fibula between the displaced PM fragment and the tibia was associated with Bartoníček / Rammelt types 2 and 3 PM fractures.
Seventy prevent of all reported BF are associated with a PM fracture. The true prevalence may be even higher because of the historically infrequent use of CT imaging. The pathoanatomy of the PM fragment is highly variable as is the kind of fibular displacement in BF. Therefore, CT scanning should be performed routinely in BF. Displaced PM fractures in BF involving the incisura should be treated operatively via a direct posterolateral approach.
后踝骨折（PM）与踝骨折的不良预后有关。本研究旨在分析 Bosworth 骨折脱位（BF）中 PM 骨折的发生率和病理解剖结构。
对在我院治疗的 13 例患者和在系统文献检索中确定的 1947 年至 2018 年间发表的 97 例患者的 X 线和计算机断层扫描（CT）进行评估，以了解 BF 的病理解剖结构。在本研究的所有 13 例患者和文献中的 10 例患者中，均进行了轴向 CT 扫描。
本系列中的 13 例（100%）BF 患者和文献中 97 例（63%）BF 患者均存在 PM 骨折。在进行完整 CT 分析的患者中，腓骨向后踝胫骨边缘的脱位与额外的（Bartoníček / Rammelt 1 型）PM 骨折有关。腓骨在移位的 PM 骨折块和胫骨之间的移位与 Bartoníček / Rammelt 2 型和 3 型 PM 骨折有关。
所有报道的 BF 中有 70%与 PM 骨折有关。由于历史上 CT 成像的应用频率较低，实际的患病率可能更高。PM 骨折块的病理解剖结构高度可变，BF 中腓骨的移位类型也多种多样。因此，BF 应常规行 CT 扫描。涉及切迹的 BF 中移位的 PM 骨折应通过直接后外侧入路进行手术治疗。
