#BIMALLEOLAR FX SKIN#

Patient claims that his cleats gripped the turf and twisted his ankle in an external rotation fashion.Ĭlosed reduction was attempted at the transferring institute under conscious sedation with minimal improvement of bony alignment. The mechanism of injury was a 'slide tackle' in which a soccer player leaves his feet with one leg extended in the hopes of taking the ball away from an opposing player, a move the patient was comfortable with. On the date of injury, the patient was playing soccer at an indoor facility equipped with synthetic turf with typical soccer cleats. A case report is presented below to help accurately diagnose and treat the Bosworth ankle fracture-dislocation.Ī 35-year-old male was transferred to our facility for higher level of care, complaining of a left ankle fracture sustained while playing soccer the previous day. With the pressure for more middle level practitioners, the possibility for more unrecognized diagnosis is inevitable. 2,3 Yet this fracture-dislocation is often misdiagnosed and mistreated, potentially leading to devastating consequences. 2,3 New information has been presented with several of these publications including age variations, cases with intact fibulas, level of the fracture in relationship to the syndesmosis, mechanism of injury, cases with successful close reduction, and additional injury. 1Īpproximately sixty Bosworth fracture-dislocation cases have been documented since Bosworth’s initial description. Five patients were described in the original paper: two fracture-dislocations were not recognized, leading to malunion and eventually requiring arthrodesis one fracture-dislocation was recognized late but appropriately treated with satisfactory results and the remaining two fracture-dislocations were recognized and treated, leading to excellent results. 1 This fracture-dislocation was described as an irreducible dislocation of the proximal aspect of the distal fibula posterior to the tibia. Misdiagnosis or mistreatment has historically left patients disabled, in pain, arthritic, unsatisfied, and in need of more drastic surgical options.īosworth ankle fracture-dislocation is a rare yet severe injury that was originally described in 1947 by David Bosworth, M.D.

#BIMALLEOLAR FX SKIN#

2 Practitioners have methodically improved treatment protocols for this injury, effectively reducing the risk of complications, which include severe soft tissue swelling, compartment syndrome, skin necrosis, and unsuccessful attempts at close reduction. Case reports date back to 1836 in which the fibula was dislocated posteriorly in an ankle fracture.

This rare injury is presented in the following case of a 35-year-old male who underwent an open reduction and internal fixation after multiple failed closed reduction attempts.Īnkle fracture-dislocations are common injuries that have long been noted by the medical community and patients alike. If recognized, however, these injuries can be successfully treated via early open reduction and internal fixation. This potential oversight can lead to improper treatment in the emergency room and a poor outcome for the patient. In a Bosworth fracture, however, the proximal aspect of the distal fibula lodges posteriorly to the tibia, making closed reduction nearly impossible.

On initial clinical exam and radiographs, it appears to be a routine ankle fracture. The Bosworth fracture-dislocation is a rare and potentially problematic ankle injury.

Riverside County Regional Medical Center, Moreno Valley, CA

Anthony Silverio, DO, Eric Rebich, DO, Michael Basso-Williams, DO, Nicolas Vardiabasis, DO,

Bimalleolar fx