Bosworth fracture

Bosworth fracture
Synonyms	Bosworth injury
Pronounce	N/A
Specialty	N/A
Symptoms	Ankle pain, swelling, deformity
Complications	Compartment syndrome, vascular injury, nerve injury
Onset	Sudden, due to trauma
Duration	Varies, depending on treatment
Types	N/A
Causes	Ankle fracture with posterior dislocation of the fibula
Risks	High-energy trauma, sports injuries, falls
Diagnosis	Physical examination, X-ray, CT scan
Differential diagnosis	Ankle dislocation, Pilon fracture, Maisonneuve fracture
Prevention	N/A
Treatment	Closed reduction, open reduction and internal fixation
Medication	N/A
Prognosis	Good with appropriate treatment
Frequency	Rare
Deaths	N/A

A rare type of ankle fracture-dislocation

Bosworth fracture is a rare and complex type of ankle fracture characterized by the entrapment of the fibula behind the tibia. This injury is named after David M. Bosworth, who first described it in 1947. It is a specific form of fracture-dislocation that poses significant challenges in diagnosis and management due to its unusual presentation and the potential for complications.

Pathophysiology

A Bosworth fracture occurs when there is a fracture of the fibula accompanied by posterior dislocation of the fibular fragment behind the tibia. This results in a fixed posterior dislocation of the talus and the ankle joint. The mechanism of injury typically involves a combination of external rotation and abduction forces applied to the ankle, often during high-energy trauma such as a fall from a height or a motor vehicle accident.

Clinical Presentation

Patients with a Bosworth fracture usually present with severe pain, swelling, and deformity of the ankle. The affected limb may appear shortened and externally rotated. Due to the entrapment of the fibula, attempts at closed reduction are often unsuccessful, and the condition may be misdiagnosed as a simple ankle fracture or dislocation.

Diagnosis

The diagnosis of a Bosworth fracture is primarily made through radiographic imaging. Standard X-rays of the ankle may reveal the posterior displacement of the fibula and the associated fracture. However, due to the complexity of the injury, additional imaging such as CT scan or MRI may be required to fully assess the extent of the injury and plan for surgical intervention.

Treatment

The treatment of a Bosworth fracture typically involves surgical intervention. The primary goal of surgery is to achieve anatomical reduction of the fibula and restore the normal alignment of the ankle joint. This often requires open reduction and internal fixation (ORIF) to reposition the fibula and stabilize the fracture. Postoperative care includes immobilization of the ankle, followed by a period of rehabilitation to restore function and strength.

Prognosis

The prognosis for patients with a Bosworth fracture depends on the timeliness and effectiveness of the treatment. Early diagnosis and appropriate surgical management are crucial for a favorable outcome. Delayed treatment or misdiagnosis can lead to complications such as chronic pain, joint stiffness, and post-traumatic arthritis.

Related pages

• Ankle fracture
• Dislocation
• Orthopedic surgery
• Trauma surgery