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Lawson KA, Ayala AE, Morin ML, Latt LD, Wild JR. Republication of "Ankle Fracture-Dislocations: A Review". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231195058. [PMID: 37582190 PMCID: PMC10423454 DOI: 10.1177/24730114231195058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Ankle fractures are common musculoskeletal injuries that may result in tibiotalar joint dislocations. Ankle fracture-dislocations occur via similar mechanisms as ankle fractures, although the persistence or magnitude of the deforming force is sufficient to disrupt any remaining bony or soft-tissue stability. Ankle fracture-dislocations likely represent distinct clinical entities, as the pathology, management, and patient outcomes following these injuries differ from those seen in more common ankle fractures without dislocation. Ankle fracture-dislocations have higher rates of concomitant injury including open fractures, chondral lesions, and intra-articular loose bodies. Long-term outcomes in ankle fracture-dislocations are worse than ankle fractures without dislocation. Higher rates of posttraumatic osteoarthritis and chronic pain have also been reported. In this review, we discuss the current literature regarding the history, management, and outcomes of ankle-fracture dislocations and highlight the need for future study.
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Affiliation(s)
- Kevin A Lawson
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Alfonso E Ayala
- The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Matthew L Morin
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - L Daniel Latt
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jason R Wild
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine, Tucson, AZ, USA
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Heinecke M, Hofmann GO, Mendel T. Irreducible Ankle Fracture Due to Incarceration of the Long Flexor Tendons Together With the Neurovascular Bundle in the Tibial Fibular Interosseous Space: A Case Report and Short Literature Review. J Foot Ankle Surg 2021; 59:849-852. [PMID: 32345508 DOI: 10.1053/j.jfas.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 08/31/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Abstract
Ankle fracture dislocations with frustrating attempts at closed reduction are a rare traumatic entity. We present a case of an irreducible ankle fracture due to incarceration of all the flexor tendons including the neurovascular bundle in the tibial fibular interosseous space; to date, only one such case has been published in the literature. A computed tomography scan in both bone and soft tissue windows was necessary to clarify the structures that were inhibiting repositioning. The decisive step for surgical treatment was removal of the trapped structures from the tibial fibular interosseous space by a dorsomedial approach. The malleolar joint was then reconstructed anatomically. After 12 weeks, the patient was fully mobile without restrictions in his daily professional activities.
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Affiliation(s)
- Markus Heinecke
- Consultant, Hospital for Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost Halle gGmbH, Halle/S., Germany.
| | - Gunther O Hofmann
- Consultant, Hospital for Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost Halle gGmbH, Halle/S., Germany; Professor, Hospital for Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Thomas Mendel
- Consultant, Hospital for Trauma and Reconstructive Surgery, BG Hospital Bergmannstrost Halle gGmbH, Halle/S., Germany; Senior Physician, Hospital for Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
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Abstract
A luxation fracture of the ankle characterized by a dislocation of the fibula posterior to the tibial tubercle is defined as a Bosworth injury. The Bosworth fracture is a frequently overlooked complex injury of the ankle joint. Associated injuries such as a pilon fracture and posterior malleolus fracture have rarely been reported. In the case of a closed irreducible ankle fracture dislocation, Bosworth injuries should be considered as a potential cause. This article reports the course, treatment and clinical outcome 12 months after trauma of a Bosworth fracture with associated impaction of the posteromedial pilon and fracture of the posterior malleolus. To date, there are only few reports of comparable injuries in the German language literature.
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Lawson KA, Ayala AE, Morin ML, Latt LD, Wild JR. Ankle Fracture-Dislocations. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418765122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Ankle fractures are common musculoskeletal injuries that may result in tibiotalar joint dislocations. Ankle fracture-dislocations occur via similar mechanisms as ankle fractures, although the persistence or magnitude of the deforming force is sufficient to disrupt any remaining bony or soft-tissue stability. Ankle fracture-dislocations likely represent distinct clinical entities, as the pathology, management, and patient outcomes following these injuries differ from those seen in more common ankle fractures without dislocation. Ankle fracture-dislocations have higher rates of concomitant injury including open fractures, chondral lesions, and intra-articular loose bodies. Long-term outcomes in ankle fracture-dislocations are worse than ankle fractures without dislocation. Higher rates of posttraumatic osteoarthritis and chronic pain have also been reported. In this review, we discuss the current literature regarding the history, management, and outcomes of ankle-fracture dislocations and highlight the need for future study.
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Affiliation(s)
- Kevin A. Lawson
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Matthew L. Morin
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jason R. Wild
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine, Tucson, AZ, USA
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Lee C, Douglas TJ. Irreducible Ankle Fracture from an Interposed Chaput Fragment: A Case Report. JBJS Case Connect 2017; 7:e42. [PMID: 29244680 DOI: 10.2106/jbjs.cc.16.00176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 23-year-old active-duty military service member sustained an unusual irreducible fracture-dislocation of the ankle joint. Preoperative computed tomography showed an anterolateral tibial (Chaput) fragment entrapped within the distal syndesmosis, preventing adequate reduction. An open reduction of the fragment was performed in the operating room, which allowed near-anatomic reduction and internal fixation of the tibiotalar joint. At the 21-month follow-up visit, the patient remained on active duty in the Navy without limitations. CONCLUSION To our knowledge, this rare injury pattern, an interposed Chaput fragment preventing closed reduction of the syndesmosis in a skeletally mature patient, has not previously been described in the literature. An open reduction and internal fixation of the Chaput fragment allowed near-anatomic reduction of the tibiotalar joint.
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Affiliation(s)
- Chihua Lee
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
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Cappuccio M, Leonetti D, Di Matteo B, Tigani D. An uncommon case of irreducible ankle fracture-dislocation: the "Bosworth-like" tibio-fibular fracture. Foot Ankle Surg 2017; 23:e1-e4. [PMID: 28159051 DOI: 10.1016/j.fas.2016.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/21/2016] [Accepted: 07/02/2016] [Indexed: 02/04/2023]
Abstract
An irreducible ankle-fracture dislocation characterized by the dislocation of the proximal fragment of the fibula posteriorly to the tibial tubercle is defined as "Bosworth injury". In the present report it is described, for the first time in literature, a complex case where the Bosworth injury was associated to a tibial plafond fracture: the proximal fibular fragment was entrapped between the tibial pilon and the fractured posterior tibial tubercle, which acted as a clamp, thus avoiding ankle reduction. Due to the presence of the tibial fracture, it was not possible to observe the typical radiological signs of Bosworth injury and therefore two unsuccessful reductions were attempted before performing a CT scan that revealed the complexity of the case, that required an immediate ORIF procedure to prevent the onset of complications.
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Affiliation(s)
- Michele Cappuccio
- Department of Orthopaedics, Maggiore Hospital, Largo Nigrisoli n. 2, 40100 Bologna, Italy
| | - Danilo Leonetti
- Department of Orthopaedics, Maggiore Hospital, Largo Nigrisoli n. 2, 40100 Bologna, Italy
| | - Berardo Di Matteo
- Biomechanics Laboratory and II Orthopaedic Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano n. 1/10, 40100 Bologna, Italy.
| | - Domenico Tigani
- Department of Orthopaedics, Maggiore Hospital, Largo Nigrisoli n. 2, 40100 Bologna, Italy
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Natoli RM, Summers HD. Irreducible ankle fracture-dislocation due to tibialis anterior subluxation: a case report. J Foot Ankle Surg 2015; 54:268-72. [PMID: 25618805 DOI: 10.1053/j.jfas.2014.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Indexed: 02/03/2023]
Abstract
Irreducible ankle fracture-dislocations are rare. Several cases of irreducible ankle fracture-dislocation have been reported in published studies secondary to the tibialis posterior tendon, deltoid ligament, or extensor digitorum longus tendon blocking the reduction. We report a case of irreducible ankle fracture-dislocation resulting from posteromedial subluxation of the tibialis anterior tendon around a medial malleolar fracture fragment. Ultimately, the ankle required open reduction of the incarcerated tendon to reduce the joint and proceed with internal fixation of the associated fracture. The patient's postoperative course was uncomplicated, and the tibialis anterior tendon was functioning at 10 months postoperatively, after which he did not return for follow-up examinations. To our knowledge, this is the first reported case of the tibialis anterior tendon blocking closed reduction of an ankle fracture-dislocation.
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Affiliation(s)
- Roman M Natoli
- Senior Resident, Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL
| | - Hobie D Summers
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL.
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Sofka CM. Postoperative magnetic resonance imaging of the foot and ankle. J Magn Reson Imaging 2013; 37:556-65. [DOI: 10.1002/jmri.23792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 07/27/2012] [Indexed: 11/06/2022] Open
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Schepers T, Hagenaars T, Den Hartog D. An irreducible ankle fracture dislocation: the Bosworth injury. J Foot Ankle Surg 2012; 51:501-3. [PMID: 22632841 DOI: 10.1053/j.jfas.2012.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Indexed: 02/03/2023]
Abstract
Irreducible fracture dislocations of the ankle are rare and represent true orthopedic emergencies. We present a case of a fracture dislocation that was irreducible owing to a fixed dislocation of the proximal fibular fragment posterior to the lateral ridge of the tibia. This particular type of injury, known as a Bosworth fracture dislocation, was not appreciated on the initial radiographs taken in the emergency room but was identified at urgent surgical management. The trauma mechanism, radiographs, treatment, and relevant published data are discussed in the present report.
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Affiliation(s)
- Tim Schepers
- Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Ellanti P, Hammad Y, Kosutic D, Grieve PP. Irreducible tibial pilon fracture caused by incarceration of the fibula in the tibial medullary canal. J Foot Ankle Surg 2011; 51:362-4. [PMID: 22153657 DOI: 10.1053/j.jfas.2011.10.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Indexed: 02/03/2023]
Abstract
Fractures can be irreducible for several reasons, including soft tissue or bone fragment interposition. We report an unusual fracture configuration of a comminuted tibial pilon fracture in which the distal fibular shaft fragment was occupying the medullary canal of the proximal tibial shaft fragment and inhibiting reduction and fixation. To the best of our knowledge, this has not been previously reported in a published study.
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Affiliation(s)
- Prasad Ellanti
- Department of Trauma and Orthopaedic Surgery, St. James's Hospital, Dublin, Republic of Ireland.
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Soulier R, Fallat L. Irreducible Salter Harris type II distal tibial physeal fracture secondary to interposition of the posterior tibial tendon: a case report. J Foot Ankle Surg 2010; 49:399.e5-9. [PMID: 20610206 DOI: 10.1053/j.jfas.2010.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Indexed: 02/03/2023]
Abstract
Pediatric distal tibial fractures generally occur without significant long-term sequelae, and patients are commonly able to return to their preinjury activities after proper management. The literature reports excellent outcomes after anatomical reduction of distal tibial and ankle physeal fractures with closed or open treatment. Treatment options include simple immobilization of nondisplaced fractures, and closed or open reduction for restoration of anatomic alignment of displaced fractures. Soft tissue interposition within the fracture can threaten successful closed reduction, and may warrant open management if closed reduction fails to produce a satisfactory result. Despite the documented possibility of soft tissue interposition preventing closed reduction of pediatric ankle fractures, there is a paucity of literature reporting this complication. We report a unique case of an irreducible Salter-Harris type II distal tibial physeal fracture secondary to interposition of the posterior tibial tendon.
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Affiliation(s)
- Robert Soulier
- Oakwood Annapolis Hospital, Oakwood Healthcare System, Wayne, MI, USA
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