PMC8828915_01
First attempted closed reduction of images: (a) Anteroposterior radiograph shows medial malleolus the axilla sign (yellow arrow). (b) Lateral radiograph show posterior subluxation of the talus. Axial CT scan (c) showing that the proximal fragment of the fibula was locked between the anterior part of the fibular notch and the posterior tibial fragment (yellow arrow). CT soft tissue reconstruction showing posterior tibial tendon (d) (yellow arrow) and flexor hallucis longus (d) (red arrow) located in the anatomical position.
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F1
The proximal fragment of fibula was displaced and entrapped posteriorly into the gap between the anterior part of the fibular notch and the posterior tibial fragment, consistent with Bosworth fracture-dislocation (Figure 1).
Post-manipulative radiographs show the anatomical alignment of the ankle mortise following closed reduction and external fixation. Anteroposterior (a) and lateral (b). Post-manipulative CT showed normal tibiofibular syndesmosis (yellow arrow). CT axial scans (c) and 3D CT (d).
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F2
Post-reduction films showed anatomical reduction (Figure 2).
Anteroposterior (a) and lateral (b) radiographs of the right ankle at 30 months of follow-up showed normal alignment of the ankle. CT axial scans (c) show the normal syndesmosis (yellow arrow). The general images of ankle range of motion (dorsiflexion and plantarflexion) and subtalar joint range of motion showed no difference compared to the left ankle (d).
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F3
At 30 months of follow-up, he showed a normal gait and full dorsiflexion and plantarflexion, and had no neurovascular complaints, no osteochondral dissecans of the talus or tibial plafond, or post-traumatic osteoarthrosis (Figure 3).