An Unusual Presentation of Fracture Ankle-A case report

An Unusual Presentation of Fracture Ankle – A Case Report

Abstract

Fractures around ankle are quite common and sometimes they are irreducible. Bosworth fracture dislocation has been described in which distal end of proximal fragment of fibula is displaced behind posterolateral ridge of the distal tibia and locked there. This situation is not recognized unless one is aware that it can occur and reduction is possible only through open reduction. We would like to present a rare case in which proximal end of distal fragment of fibula was displaced posterior to tibia and locked there (opposite of Bosworth lesion).
Case report-In our case proximal end distal fragment of fibula was displaced posterior to tibia and locked there which could not be released by closed reduction or heavy skeletal traction. Operative findings – posterolateral ridge of tibia with intact interosseous membrane and soft tissue interposition were the root cause. After reduction eight hole 1/3rd tubular plating was done with six A/O cancellous screws of 3.5mm. For comminuted fracture of tibia – fixator frame was made by inserting another stein man’s pin in middle 1/3rd and joined with calcaneum pin by tubular rods.
Discussion- Irreducible fracture dislocations around ankle joint have been described by various authors. The known causes are interposition of deltoid ligament, tibialis posterior and extensor tendons. In a typical Bosworth lesion upper fragment of fibula gets locked but in our case because lower fragment was locked we would call this as “Reverse Bosworth fracture dislocationâ€. Our case was different from others also because lower tibia was also comminuted with contusion.
Conclusion-Knowledge of the existence of Bosworth fracture dislocation and its variant will increase the awareness of its existence. Prompt recognition of its characteristic clinical and radiological features will lead to appropriate surgical treatment to prevent complications and minimize permanent disability in these patients.