Posterior fracture-dislocation of the distal part of the fibula. Mechanism and staging of injury.

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

“…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].…”

“…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. Initially the investigators divided the anterior and posterior inferior tibiofibular ligaments before applying an external rotation and supination force to the ankle to demonstrate the fracture pattern and described them in stages [5].…”

“…It is our view that Bosworth fracture-dislocations should be treated with urgency when the distal portion of the proximal fibula is not able to be close reduced after a few attempts then open reduction with operative stabilization should be performed. 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].…”

“…Perry et al [5] Posterior fracture-dislocation of the distal part of the fibula. Found a consistent radiographic sign on the mortise view at the axilla of the medial tibial plafond due to internal rotation of the tibia from the posteriorly perched proximal fibula fragment Radiographic clue to Bosworth fracture dislocation is a "axilla sign"…”

Fracture-luxation de cheville avec luxation r�trotibiale de la fibula (fracture de Bosworth): � propos de 2 cas*

“…Elles correspondent en réalité à une forme incomplète de la lésion, pour laquelle la cascade traumatique est interrompue précocement, n'atteignant pas le stade fracturaire. Perry [14] décrit les différents stades lésionnels lors d'une étude cadavérique reprenant les travaux d'Huguier [8]. Il reproduit le mécanisme de la fracture en contraignant la cheville en rotation externe sur un pied bloqué en supination (Tableau 1).…”