An Irreducible Ankle Fracture Dislocation: The Bosworth Injury

Abstract

Irreducible fracture dislocations of the ankle are rare and represent true orthopedic emergencies. We present a case of a fracture dislocation that was irreducible owing to a fixed dislocation of the proximal fibular fragment posterior to the lateral ridge of the tibia. This particular type of injury, known as a Bosworth fracture dislocation, was not appreciated on the initial radiographs taken in the emergency room but was identified at urgent surgical management. The trauma mechanism, radiographs, treatment, and relevant published data are discussed in the present report.

Irreducible Ankle Fracture Dislocation Due to Tibialis Posterior Tendon Interposition: A Case Report

“…A recent case has been described of tibialis anterior subluxation leading to the inability to adequately reduce an ankle fracture and dislocation, which was previously undocumented (8). In addition, a case of posterior dislocation of the fibula behind the distal tibial that obstructed ankle fracture relocation has been reported (9). In our patient, radiographically, the talus was noted to be significantly laterally displaced.…”

Rare Ankle Fracture Pattern: Bosworth Fracture can Lead to Post-Traumatic Arthritis if Unrecognized Early

“…It is also our recommendation after review of the literature that fixation should be performed urgently, within 24-48 hours after injury. Urgent surgery may help decrease the risk of posttraumatic arthritis and by paying close attention to the reduction of the distal fibula fracturedislocation [1,[6][7][8]10,11]. The actual incidence of Bosworth fracture-dislocations appear to be rare but the consequences of non-recognition can be detrimental to the patient.…”

“…A radiographical axilla of the medial tibial plafond is visible on x-ray due to internal rotation of the tibia when the fibula is dislocated posterior to the tibia [9]. Bosworth's original paper, as well as subsequent papers describes difficulty with reduction of this type of fracture and the necessity for operative treatment instead of non-operative management [2][3][4][5][6][7][8]10,11]. Open reduction with internal fixation and close examination of the syndesmosis with increased likelihood of syndesmotic fixation is the treatment of choice [1,6].…”

“…Bosworth's original paper, as well as subsequent papers describes difficulty with reduction of this type of fracture and the necessity for operative treatment instead of non-operative management [2][3][4][5][6][7][8]10,11]. Open reduction with internal fixation and close examination of the syndesmosis with increased likelihood of syndesmotic fixation is the treatment of choice [1,6]. Posttraumatic arthritis is a known complication from initial nonoperative treatment or failure to recognize this type of fracturedislocation or inadequate fixation.…”

An Unusual Ankle Injury: The Bosworth-Pilon Fracture

“…Although this had been described earlier by several investigators, the pattern of injury has become known as the Bosworth injury. Since the original reports, >60 cases have been reported in published studies, and a Bosworth injury has been recognized as a cause of irreducible ankle dislocation (2)(3)(4)(5). A pilon fracture is a fracture of the distal tibia caused by high-energy axial loading of the ankle, driving the talus into the tibial plafond.…”