Superficial Peroneal Nerve Laceration and Repair in the Setting of a Bosworth Fracture: A Case Report

Abstract

The superficial peroneal nerve (SPN) is at increased risk of injury in the setting of ankle fractures. We report a case of SPN laceration in the setting of a Bosworth fracture that likely occurred as the fibula became entrapped behind the tibia upon initial injury, pulling the SPN posterior and resulting in a traction tear. Radiographic evaluation performed when the patient presented to the emergency department demonstrated a Bosworth fracture, widening of the medial clear space, and posterior ankle dislocation. Closed reduction was attempted. Although the fibula remained entrapped behind the tibia, the talus was successfully reduced, and a short leg splint was applied. Fracture fixation and acute, direct repair of the nerve were completed during operative fixation 15 days from the initial injury, following the resolution of soft tissue swelling. The patient reported a complete return of sensation in SPN distribution 2 weeks postoperatively. Radiography showed an anatomically reduced ankle with hardware intact and in place. At 1-year follow-up, SPN sensation remained intact, radiography ultimately indicated a healed fracture site, and the patient reported that she was able to ambulate without pain. Our case provides support for acute, direct repair of SPN lacerations in concomitant Bosworth fractures. Level of Evidence: Level V, case report.