Bosworth骨折脱位，可否合并后踝骨折？

Bosworth骨折由美国医生David Marsh Bosworth于1947年首先报道，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、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。为少见的踝关节骨折脱位。

Bosworth骨折通常伴有外踝下胫腓韧带水平的骨折，腓骨交锁、脱位后，外旋暴力是否持续导致后踝骨折？而后踝骨折的存在与否，则与踝关节骨折预后息息相关。

为此，有学者汇报了一组Bosworth骨折病例，并回顾相关文献，以研究Bosworth骨折合并后踝骨折的几率。

[Objectives: 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 fracturedislocations (BF).]

图1 典型Bosworth骨折病例。

图2 移位的腓骨骨折合并无移位的后踝骨折。

图3 移位的腓骨骨块位于胫骨后侧与后踝骨块之间。

图4 图1X线平片患者的三维重建。可见后踝骨块向内侧延伸。

本系列的所有13名Bosworth骨折患者(100%)和文献记载的97例中的61例(63%)均与后踝骨折相关。在有完整CT分析的患者中，胫骨后缘后腓骨脱位与切迹外(bartony cek/Rammelt 1型)后踝骨折相关。移位的后踝骨块和胫骨之间的腓骨移位与bartony cek/Rammelt 2型和3型后踝骨折相关。

[Results: 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 (Bartonícek ˇ / Rammelt type 1) PM fracures. Displacement of the fibula between the displaced PM fragment and the tibia was associated with Bartonícek ˇ / Rammelt types 2 and 3 PM fractures.]