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

Hancock, Jonathan B

doi:10.15406/mojor.2015.02.00031

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…Little is known about the outcome of BF because the majority of authors followed their patients merely for several weeks or months, and some did not present any results at all (1,2,3,5,6,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,…”

Section: Resultsmentioning

confidence: 99%

Section: Literature Reviewmentioning

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%

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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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Section: Resultsmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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Bosworth ankle fracture-dislocation: current concept review

Bartoníček,

Rammelt,

Tuček

2024

EFORT Open Reviews

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“…The "axilla sign" is a radiographic marker that can help identify the Bosworth fracture-dislocation [4]. Bosworth's original paper as well as subsequent literature articles cite the difficulty of this type of fracture pattern and the necessity for operative treatment [5]. To date, there has been no closed reduction technique described for this fracture pattern.…”

Section: Discussionmentioning

confidence: 99%

“…Early recognition of a Bosworth fracture-dislocation is crucial, as associated soft tissue damage and compartment syndrome have been reported. Delays in adequate treatment are linked with inferior clinical outcomes, with the majority requiring early open reduction and internal fixation [5][6][7][8]. We present a case report of a 34-year-old male who underwent a rare, successful closed reduction allowing for delayed open reduction with internal fixation without complication.…”

Section: Introductionmentioning

confidence: 97%

A Novel Technique for a Successful Closed Reduction of a Bosworth Fracture-Dislocation of the Ankle

Fan

Michelin

Jenkins

et al. 2020

Cureus

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The Bosworth fracture is defined as a bimalleolar fracture-dislocation of the ankle, with entrapment of the fibula behind the posterior tubercle of the distal tibia. In the current orthopedic literature, not only is this fracture pattern rare, but this type of fracture-dislocation has also been reported to be near impossible to close reduce, with the majority requiring early open reduction and internal fixation to prevent complications and poor clinical outcomes. Reported early complications include compartment syndrome and soft tissue complications from repeated closed reduction attempts. Complications associated with delayed operative intervention include post-traumatic adhesive capsulitis of the ankle and ankle stiffness. We present a case study of a 34-year-old male who sustained a Bosworth fracture-dislocation of the right ankle after a skateboarding accident. We describe a successful closed reduction performed in the emergency department, with a novel closed reduction technique. The patient tolerated the procedure well, with no complications. He was then scheduled for open reduction and internal fixation five days afterward, and upon post-operative follow-up, he recovered well with no complications. This technique focuses on reduction forces applied to the proximal fibular fragment, which is entrapped behind the posterolateral portion of the tibia. We believe that the key to successful reduction is applying an anterolateral/internal rotation force to this entrapped fragment. If successful, this fracture pattern may not require admission for compartment checks or early open reduction and internal fixation, thereby preventing complications and poor clinical outcomes. Our technique allows for a successful closed reduction of Bosworth fractures; however, further research exploring this reduction technique is warranted.

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