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Case Reports
. 2020 Jun 27:28:100322.
doi: 10.1016/j.tcr.2020.100322. eCollection 2020 Aug.

Bosworth fracture. An atypical case of irreducible ankle fracture-dislocation

Francisco Jose Martin-Somoza  1 , David Ruiz Picazo  1 , Jesús Amador Martinez Cabezuelo  1 , Ana Verdejo González  1
Affiliations
Case Reports

Bosworth fracture. An atypical case of irreducible ankle fracture-dislocation

Francisco Jose Martin-Somoza et al. Trauma Case Rep. .

Abstract

An irreducible ankle-fracture dislocation in which the proximal fibular shaft fragment locks behind the posterior tibial tubercle is defined as "The Bosworth injury". Characteristically, this fracture is generally not reducible using closed methods. A high number of attempts can be counterproductive to get a good final functional result and it may also lead to the appearance of future complications. Although it is a recognized and published cause of irreducible ankle dislocation, it is an unusual and rare injury. The initial radiological diagnosis is difficult, usually going unnoticed, and it is frequently diagnosed during the surgical act, appreciating the retrotibial position of the proximal fibular fragment. The present report is the first in the medical data to describe a case of Bosworth injury in a 32-week-old pregnant woman. The initial diagnosis went unnoticed. After unsuccessful closed reduction attempt, urgent surgical intervention was performed.

Keywords: Ankle; Bosworth fracture; Irreducible fracture-dislocation; Surgical treatment.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
A) Initial anterior-posterior (AP) and lateral (L) radiographs. Trimalleolar ankle fracture dislocation. The study has been altered by the patient's incapacity to maintain an adequate position. B) Control radiograph after the first closed reduction attempt. As we can observe, there's a persistent incongruity and the components of the fracture haven't moved from their original position, although classic reduction techniques have been performed.
Fig. 2
Fig. 2
A) Fluoroscopic images after the second closed reduction attempt in the operating theatre. Unsuccessful reduction. B) Articular surface of the distal tibiofibular joint (intermediate thickness arrow). Proximal fibular shaft entrapped behind the tibia (thick arrow). Talus (thin arrow).
Fig. 3
Fig. 3
A) X-ray image four weeks after surgery. B) Control radiograph one year after the surgery. We can observe fracture consolidation with good joint congruence.
See this image and copyright information in PMC

References

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