踝关节Bosworth fracture

     ，Bowsworth骨折是由美国David Marsh Bosworth医生于1947年首先报道的特殊类型踝关节骨折、脱位之一。其特点是外旋暴力导致踝关节骨折脱位，伴腓骨近端骨折移位、并交锁于胫骨后嵴处。因骨间膜、韧带及腓骨肌腱被拉紧，闭合手法复位比较困难，常需手术切开复位，多次闭合复位将加重软组织损伤和术后疤痕。早期并发症注意骨筋膜室综合症，晚期并发症注意OA，距骨坏死，踝关节运动受限等。

   35岁男性，1米高梯子摔落致右踝损伤，影像学提示Bowsworth骨折，腓骨Weber B型骨折。

Fig. 1. Post-injury radiograph showing tibiofibular overlap, posterior subluxation of the talus and a small displaced fragment of the posterior malleolus.

    尝试手法闭合复位，胫距关节复位，但胫腓关节无法复位。

Fig. 2. Radiograph after closed reduction, with persis- tively, showed a persisting slight edema, with a ting tibiofibular overlap and marked tibiofibular dissociation in the lateral view.

     予以手术治疗，切开撬拨解剖复位后，内固定。胫腓前韧带完整（大部分病例断裂），后踝为Bartonı´cˇek-Rammelt I型骨折，未予固定；复位后稳定，未予修复三角韧带。术后石膏固定6周。

Fig. 3. Postoperative radiograph showing anatomical reduction, with the exception of the posterior malleolus fragment.

术后1年随访

术后13年随访

CT reconstructions confirming anatomical reduction. Posterior view on 3D CT reconstruction shows a defect following marginal impaction of the posterior malleolus lateral to the malleolar groove but outside the fibular notch (yellow arrow).