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

Abstract

This article describes a case report of a Bosworth fracture-dislocation with review of the current literature (Table 1) and makes recommendations as to the timing of surgical fixation to help avoid future complications such as post-traumatic arthritis. A Bosworth fracture-dislocation is a rare type of ankle fracture where the proximal portion of the fibula fracture is dislocated posterior to the incisura fibularis [1,24,5]. In most instances the distal syndesmotic ligaments are disrupted allowing for this fracture variant [5]. This type of ankle fracture is challenging to reduce if not irreducible because of the posterolateral osseous portion of the tibia preventing close reduction of the fibula [6,7]. Our case shows how this type of fracture can be close reduced. With disruption of the syndesmotic ligaments the proximal portion of the distal fibula was unstable which then allowed it to re-dislocate posterior behind the tibia after being close reduced. If this type of fracture-dislocation is not identified it can be detrimental to the function and prognosis of the patient [2,8]. Up to this point literature has not described whether this rare variant should be treated differently than typical ankle fractures as to the timing of surgical fixation.