Bosworth Fracture: A Complex and Challenging Clinical Scenario

A Bosworth fracture is a specific type of locked ankle fracture-dislocation. This injury includes a displaced fibular fracture, specifically a fragment posterior to the posterior surface of the distal tibia, at the fibular notch.¹ This injury impacts multiple anatomic structures about the ankle joint, making it a complex condition, and easily misdiagnosed. In EFORT Open Reviews, Bartoníček and team recently provided a review of current thinking on this challenging injury.¹

First, they noted the importance of diagnostic computed tomography, including 3D reconstruction. They cited the comprehensive fracture characterization, specifically with respect to any associated posterior malleolar fragment.¹ Next, they pointed out that this injury necessitates early, accurate, surgical reduction with internal fixation. Multiple attempts at closed reduction often fail, they note, and thus they stress a standard, surgical approach. Also due to the complexity of the injury, the authors point out the prevalence of soft tissue complications, notably compartment syndrome.

Even with operative intervention, the researchers acknowledge that outcomes vary. They cited reports of postoperative pain, issues with stiffness and range of motion, along with arthritic changes.¹ There is also a lack of large-sample size studies that encompass a long follow-up period. In total, meticulous and early detection via CT and early, accurate surgical reduction are key in these cases.

Reference
1.     Bartoníček J, Rammelt S, Tuček M. Bosworth ankle fracture-dislocation: current concept review. EFORT Open Rev. 2024 Jun 3;9(6):448-457. doi: 10.1530/EOR-23-0050. PMID: 38828971.