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Unlocking the Complexity of Bosworth Fracture-Dislocations: A Comprehensive Review and Case Analysis

Josh Edgar Barros Prieto, Eduardo Noboa, Carlos PJeñaherrera Carrillo, Francisco Endara, Alejandro Xavier Barros Castro

The Bosworth Fracture (BF) dislocation is a rare but serious ankle injury that remains a significant diagnostic and therapeutic challenge. First described by David March Bosworth in 1947, this condition is characterized by the entrapment of the fractured fibula behind the tibia, resulting in a locked ankle. Despite its rarity, BF is often misdiagnosed or mistaken for more common ankle fractures, leading to inadequate treatment and poor outcomes. This literature review, combined with a case study from our institution, aims to focus on the complexities of BF, emphasizing the importance of early recognition and appropriate management to prevent complications.

BF can present in various forms, with the classic transsyndesmotic (Weber B) fracture being the most common. However, suprasyndesmotic (Weber C) fractures and associations with Maisonneuve fractures have also been documented. The injury mechanism typically involves an external rotation force on a supinated foot, causing the fibula to become trapped behind the tibia. This displacement is a key differentiating factor from other ankle injuries and necessitates a high index of suspicion for accurate diagnosis.

Advanced imaging, particularly Computed Tomography (CT) with 3D reconstructions, is important for diagnosing BF and planning surgical treatment. The primary goal of treatment is to restore ankle stability and congruence through meticulous reduction and fixation of all fracture components. Early intervention, typically through Open Reduction and Internal Fixation (ORIF), is essential to avoid further soft tissue damage and neurovascular complications.

This case study brings out the importance of recognizing BF as a distinct clinical entity. Increased awareness and understanding among clinicians are vital for improving patient outcomes, as timely and modified treatment can significantly reduce the risk of long-term disability. Future research should focus on larger patient cohorts and longterm follow-up to further refine management strategies for this complex injury.