Abstract
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.
Highlights
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, making closed reduction attempts largely unsuccessful [1]
We present a novel technique for a successful closed reduction of a Bosworth fracture that focuses on reduction forces applied to the proximal fibular fragment that is entrapped behind the posterolateral portion of the tibia
We propose a reasonable option to avoid urgent surgical intervention if successful closed reduction is achieved
Summary
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, making closed reduction attempts largely unsuccessful [1]. First attempted closed reduction involved standard bimalleolar ankle fracture-dislocation reduction techniques including accentuation of the injury and reduction of the tibiotalar joint with an anterior force applied to the foot with traction and dorsiflexion. After this failed attempt at a standard closed reduction technique, further assessment of radiographic imaging revealed posterior displacement of the proximal segment of the fibula behind the tibia, consistent with a Bosworth fracture-dislocation (Figure 2). Anteroposterior (A) and lateral (B) radiographs after first attempted closed reduction with notable unacceptable alignment and subluxation of the tibiotalar joint These radiographs show clearly that the proximal fibular fragment is entrapped posterior to the tibia (red arrow). The patient was again seen at six weeks post-operatively, in which his short leg cast was removed, and the patient was told to weight-bear as tolerated
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