Ankle stiffness after Bosworth fracture dislocation of the ankle

Abstract

Early recognition and prompt reduction of the dislocated ankle is important in case of Bosworth fracture dislocation in order to prevent late complication. Closed reduction of dislocated ankle is usually not helpful and repeated attempts may be harmful. Emergency operation of open reduction and internal fixation is usually required to reduce the ankle joint without delay.

Rare Ankle Fracture Pattern: Bosworth Fracture can Lead to Post-Traumatic Arthritis if Unrecognized Early

“…It is also our recommendation after review of the literature that fixation should be performed urgently, within 24-48 hours after injury. Urgent surgery may help decrease the risk of posttraumatic arthritis and by paying close attention to the reduction of the distal fibula fracturedislocation [1,[6][7][8]10,11]. The actual incidence of Bosworth fracture-dislocations appear to be rare but the consequences of non-recognition can be detrimental to the patient.…”

“…A radiographical axilla of the medial tibial plafond is visible on x-ray due to internal rotation of the tibia when the fibula is dislocated posterior to the tibia [9]. Bosworth's original paper, as well as subsequent papers describes difficulty with reduction of this type of fracture and the necessity for operative treatment instead of non-operative management [2][3][4][5][6][7][8]10,11]. Open reduction with internal fixation and close examination of the syndesmosis with increased likelihood of syndesmotic fixation is the treatment of choice [1,6].…”

“…Posttraumatic arthritis is a known complication from initial nonoperative treatment or failure to recognize this type of fracturedislocation or inadequate fixation. Posttraumatic arthritis from malunion of the unreduced proximal fibula posterior to the tibia has led to arthrodesis as an ultimate pain relieving procedure within two years of injury [2,8]. The mechanism for Bosworth's fracture-dislocations has been demonstrated with a cadaveric study showing that it is by supination and external rotation that the fracture pattern occurs.…”

“…The patient who was treated the same day had no ankle stiffness in the short term post operative follow up. Good outcomes have been reported with operative fixation of the Bosworth fracture-dislocation within 24 hours of injury [8]. Additional imaging such as a CT scan prior to surgery and posterolateral approach may allow for improved visualization for reduction and fixation of the fracture-dislocation [11].…”

“…Perry also reported only 27 percent of Bosworth's fractures have been able to be closed reduced [5]. Compartment syndrome may also be an iatrogenic cause from repeated reduction attempts resulting in additional trauma to the soft tissues [8,10,12].…”