Clinical Report: Bosworth Ankle Fracture-Dislocation Case and Surgical Insights
Overview
Bosworth fracture-dislocation is a rare ankle injury often misdiagnosed due to subtle radiographic signs and difficult closed reduction. This case study highlights the challenges of surgical management, emphasizing the importance of intraoperative positioning to achieve successful reduction and fixation.
Background
Bosworth fracture-dislocation involves entrapment of the proximal fibular fragment behind the tibial structures, complicating closed reduction efforts. Its rarity and insidious radiographic features contribute to a high rate of clinical misdiagnosis. Surgical intervention is often required when closed reduction fails. Proper intraoperative imaging and positioning are critical to avoid persistent subluxation and ensure stable fixation.
Data Highlights
A 56-year-old male presented with right ankle swelling and deformity after a fall. Initial closed reduction attempts failed. Open reduction and internal fixation via a posterolateral approach in the prone position resulted in persistent fibular entrapment. Revision surgery using a floating position allowed successful fibular release and stable syndesmotic fixation, leading to satisfactory functional recovery.
Key Findings
Bosworth fracture-dislocation is frequently misdiagnosed due to subtle radiographic features.
Entrapment of the proximal fibular fragment behind the posterior malleolus complicates closed reduction.
Initial surgery in the prone position may limit intraoperative imaging and risk unnoticed persistent subluxation.
Revision surgery using a floating position provides better exposure and allows real-time fluoroscopic monitoring.
Floating position facilitates gravity-assisted axial traction, aiding fibular release and stable fixation.
Early open reduction is recommended when closed reduction is unsuccessful to prevent complications.
Clinical Implications
Clinicians should maintain a high index of suspicion for Bosworth fracture-dislocation in ankle injuries with difficult reduction. Early surgical intervention with appropriate intraoperative positioning, such as the floating position, is essential to ensure adequate visualization and prevent reduction failure. Real-time fluoroscopy and gravity-assisted traction improve surgical outcomes.
Conclusion
Bosworth fracture-dislocation requires early recognition and tailored surgical strategies to overcome reduction challenges. Utilizing a floating position intraoperatively enhances visualization and fixation success, ultimately improving patient recovery.
References
Bosworth Ankle Fracture-Dislocation: A Case Study and Review of Existing Literature
