Bosworth fracture complicated by unrecognized compartment syndrome: a case report and review of the literature

Bartoníček, Jan; Rammelt, Stefan; Kostlivý, Karel

doi:10.1007/s00402-021-03815-1

Cited by 11 publications

(13 citation statements)

References 21 publications

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“…Patients with a displacement of the fibula behind the posterior tibial rim can have associated extra-incisural (Bartoníček/Rammelt) type 1 injury. The displacement between the posterior malleolar fragment and the tibia were associated with type 2 and 3 posterior malleolar fractures [ 11 , 20 ]. Other various soft-tissue causes for irreducibility includes interposition of the deltoid ligament on the medial side, tibialis posterior tendon on the fibular fracture site, in the syndesmotic joint or through the interosseous membrane [ 10 , 11 ] .…”

Section: Discussionmentioning

confidence: 99%

Bosworth Ankle Injuries – Treatment Challenges in Late and Neglected Presentations

Chokkalingam¹,

Samer²

2022

JOCR

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Introduction: Bosworth ankle injuries (BAIs) are rare talocrural dislocations with bi or trimalleolar fractures. Attempted closed reduction fails due to incarcerated fibular fracture behind the distal tibia. The diagnostic delay and failed attempts to restore anatomical reduction result in significant ankle swelling, compromised skin, and imminent compartment syndrome. In neglected cases with unreduced dislocation over months, capsular and tendo-Achilles contracture, additional disuse osteoporosis, adds to the complexity of surgical management. In chronic and neglected cases, literatures have no clear consensus of opinion on the type of surgical intervention and on the extent of optimization. In acute BAI, open reduction is recommended but the soft-tissue swelling may warrant staged internal fixation, after temporary external fixation. Case study: In this retrospective study we present the clinico-radiological outcome of surgically treated delayed presentation of BAI. The primary fixation in delayed cases and the role of reverse talar dome osteotomy for fusion in the chronic neglected case will be discussed. Patients were aged between 25 and 62 years, presented with isolated closed ankle injuries. Initial X-rays were consistent with BAI. The delay in presentation ranges from 2 to 49 days. All had open reduction and stabilization of the ankle. Chronic neglected case with 7 months delay had “Reverse talar dome osteotomy” for reduction of the neglected dislocation and proceeded for the primary fusion. Patients gained back their full weight-bearing mobility at an average of 12 weeks following delayed fixation. Fused ankle gained full weight-bearing mobility at 5 months post-operative period. ConclusionBosworth type of ankle dislocations are difficult injuries for closed reduction. Early diagnosis and recognition of fibular impingement require open reduction of the joint. In cases of delayed presentation, it could be challenging. Even after open reduction, a staged procedure may be warranted based on the soft tissue status. Osteotomy for joint reduction and primary fusion remains a viable option in neglected cases with an ultimate aim to regain plantigrade foot for mobility. Keywords: Bosworth ankle fracture, Irreducible ankle dislocation, Neglected ankle fracture, Primary ankle fusion, Reverse talar dome osteotomy.

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Section: Discussionmentioning

confidence: 99%

Bosworth Ankle Injuries – Treatment Challenges in Late and Neglected Presentations

Chokkalingam¹,

Samer²

2022

JOCR

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“…Other soft tissue complications associated with BF include skin necrosis (38), infection (37), and ankle stiffness, particularly after delayed reduction (7,33,54,70), or deep peroneal palsy after repeated reductions (66). Wang et al (64) described a rare complication after PM reduction and internal fixation from the posterolateral approach when postoperative CT revealed persisting dislocation of the fibula from the FN.…”

Section: Complicationsmentioning

confidence: 99%

“…We conducted an extensive literature review without time or language restrictions using relevant databases and web browsers (PubMed, Scopus, Web of Science, Google Scholar, and Google). We found a total of 179 cases reported in 72 studies dating from 1947 to 2022 ( 1 , 2 , 3 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ...…”

Section: Literature Reviewmentioning

confidence: 99%

Bosworth ankle fracture-dislocation: current concept review

Bartoníček,

Rammelt,

Tuček

2024

EFORT Open Reviews

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Bosworth fracture (BF) is a special type of locked ankle fracture-dislocation, characterized by displacement of a fragment of the fractured fibula from the fibular notch behind the posterior surface of the distal tibia. BF is a complex injury affecting multiple structures of the ankle joint, which is still frequently misjudged even today, potentially leading to severe complications. CT examination, including 3D reconstructions, should be the diagnostic standard in BF, as it provides a complete picture of the fracture pathoanatomy, most prominently the morphology of the frequently associated posterior malleolar fracture. BF requires early reduction of the displaced fibular fragment without repeated attempts on closed reduction. Non-operative treatment of BF almost always fails. The standard treatment procedure is early open reduction internal fixation. Due to the relative severity and paucity of the injury, BF seems to be particularly prone to soft tissue complications, including compartment syndrome. The results of operative treatment are mixed. Many studies report persistent pain even after a short time interval, with limitations of the range of motion or even stiffness of the ankle joint, and development of degenerative changes. Larger studies with long-term results are still missing.

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“…To our knowledge, there is only one case in the literature that has documented an isolated distal fibula dislocation without associated fractures or dislocations in the leg, and it required an open reduction [ 4 ]. Delays in reduction or incomplete reduction can increase the chances of complications, which can further delay definitive treatment or lead to additional sequelae such as soft-tissue compromise, infection, post-traumatic arthritis, compartment syndrome, chronic pain, and loss of motion [ 1 , 5 , 6 , 16 ]. There is a significant lack of literature regarding techniques for closed reduction to assist providers in managing these injuries [ 12 , 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

A rare Bosworth Variant Isolated Distal Fibula Dislocation with a Successful Closed Reduction: A Case Report and Technique

Snyder,

Mesko

2024

jocr

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Introduction: The Bosworth fracture-dislocation is a rare injury originally described as an irreducible dislocation of a distal fibula fracture where the proximal fibular fragment becomes incarcerated behind the distal tibia. There have since been a few cases described of an intact distal fibula with dislocation and similar difficulties in closed reduction attempts, typically seen with associated injuries to the ankle or proximal fibula. Regardless of the specific fracture or dislocation pattern, closed reduction attempts have consistently failed in the significant majority of these cases, which can lead to complications including soft-tissue compromise, severe post-traumatic arthritis, compartment syndrome, avascular necrosis of the talus, and neurovascular compromise. There is only one case in recent literature that describes an isolated distal fibula dislocation without associated fractures or dislocations of the lower extremity; however, it required an open reduction. Cases where a closed reduction was successful to achieve an anatomic reduction of a Bosworth-type injury are exceedingly rare. Case Report: We present a rare case of a purely ligamentous, isolated distal fibula dislocation in a 21-year-old male who underwent a successful closed reduction upon initial presentation and later underwent surgical fixation with a syndesmosis repair system. We describe the technique used for a successful closed reduction for this injury and present a 1-year follow-up with excellent outcomes. Conclusion: This is the only known case report of a successful closed reduction in an isolated distal fibula dislocation, as well as demonstrating a minimally invasive technique for definitive treatment with a syndesmosis repair system. Accurate diagnosis, early treatment, and anatomic reduction are imperative for good clinical outcomes and reducing complications for Bosworth injuries. This technique may improve the rates of successful closed reductions of Bosworth injuries upon initial presentation, leading to decreased complications and improved patient outcomes. Keywords: Bosworth, fibula dislocation, reduction technique, syndesmosis repair.

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Bosworth fracture complicated by unrecognized compartment syndrome: a case report and review of the literature

Cited by 11 publications

References 21 publications

Bosworth Ankle Injuries – Treatment Challenges in Late and Neglected Presentations

Bosworth Ankle Injuries – Treatment Challenges in Late and Neglected Presentations

Bosworth ankle fracture-dislocation: current concept review

A rare Bosworth Variant Isolated Distal Fibula Dislocation with a Successful Closed Reduction: A Case Report and Technique

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