Special Bosworth fractures: a case report and literature review
10.3760/cma.j.cn121113-20231107-00291
- VernacularTitle:特殊型Bosworth骨折一例报告及文献复习
- Author:
Liang ZHANG
1
;
Jianhua FU
;
Yiyang LIU
;
Zhaohui WANG
;
Jianwei LIU
Author Information
1. 郴州市第一人民医院创伤骨科，郴州 423000
- Keywords:
Ankle fractures;
Fibula;
Fracture dislocation;
Traction;
Bosworth fracture
- From:
Chinese Journal of Orthopaedics
2024;44(18):1233-1238
- CountryChina
- Language:Chinese
-
Abstract:
This study details a rare instance of a high fibula fracture, classified as a Bosworth fracture. A 54-year-old male presented with pain and restricted movement in his right ankle after a sprain that occurred 10 hours ago. After initial assessments he was diagnosed as a right ankle fracture with posterior dislocation, a proximal right fibula fracture, and an injury to the right lower tibiofibular joint. According to Lauge-Hansen classification this was a type IV injury charactered by pronation-external rotation. Attempts at manual reduction were unsuccessful. Further evaluation using CT scans with three-dimensional reconstruction showed a separation and dislocation at the lower tibiofibular joint, with the distal fibula interlocked with the posterolateral tibia. Additionally, comminuted fractures of the medial and posterior malleoli showed significant displacement and misalignment, leading to persistent ankle dislocation. Immediate calcaneal traction and symptomatic treatment were applied. On the third day of admission a reevaluation indicated successful reduction of the dislocated ankle and tibiofibular joint. Surgery was then performed with favorable outcome. Follow-up X-rays at one and a half years after surgery demonstrated bony heal of the fractures with normal ankle joint space and functionality. Bosworth fractures involving pronation-external rotation are notably less common than those with posterior-external rotation. When manual reduction proves ineffective, applying continuous calcaneal traction with gradual tension can help unlock fibular dislocation, thereby expediting surgical intervention.
