Anterior dislocation of the fibula resulting from surgical malreduction:a case report
10.3969/j.issn.1671-167X.2016.02.034
- VernacularTitle:手术复位不良导致的腓骨前脱位1例
- Author:
Ziyun WANG
;
Xinbao WU
- Publication Type:Journal Article
- Keywords:
Fibula;
Dislocation;
Reoperation;
Ankle joint;
Fractures,bone
- From:
Journal of Peking University(Health Sciences)
2016;48(2):361-365
- CountryChina
- Language:Chinese
-
Abstract:
SUMMARY Anklejointfractureisoneofthemostcommontypesoffracture.Therearemanyresearches on the injury mechanism,treatment principles and surgical techniques.A type of injury which combines posterior dislocation of fibula,known as the Bosworth injury,is relatively rare.In 1947,Bosworth first described this type of injury as an unusual ankle fracture dislocation with fixed posterior fracture disloca-tion of the distal part of the fibula.In this type of fracture,the proximal fibular shaft fragment locks be-hind the tibialis posterior tubercle.This rare ankle fracture variant is often not recognized in initial radio-graphs and requires a computed tomographic (CT)scan for verification.But there are already many re-ports,discussing the injury mechanism,treatment principles and surgical techniques.However,there are few reports of anterior dislocation of the fibula,caused by either injury or surgery.The mechanism of the injury is still not clear.This article reports a case of anterior dislocation of the fibula.We report a patient with left ankle open fracture (Lauge-Hansen pronation-external rotation stage Ⅲ,Gustilo ⅢA).Open reduction and internal fixation was done in the initial surgery,but ended up with poor reduction,resulting in fibula anterior dislocation,anterior dislocation of talus and tibia fibular dislocation.The fibula was dis-located anteriorly of the tibia,which rarely happened.The patient suffered severe ankle joint dysfunc-tion.The second operation took out the original internal fixation,reduced the fracture,and reset the in-ternal fixation.The function of ankle joint was improved obviously after operation.But because of the ini-tial injury and the two operations,the soft tissue around the fracture was greatly damaged.6 months after the second operation,and the fracture still not healed,so the bone graft was carried out in the third sur-gery.Two months after the third surgery,the function of the ankle was significantly better than before, but the fracture healing was poor,which needed further review.Through this case,we understand the rare type of ankle fracture with anterior dislocation of the fibula,and recognize that the timing and quality of initial surgery has a great impact on the patient’s prognosis and rehabilitation period.
