Posterior Fibular Entrapment in a Bosworth Fracture-Dislocation: A Case Report and Review of Diagnostic and Operative Considerations.

INTRODUCTION

Bosworth fracture-dislocations are rare ankle injuries characterized by posterior entrapment of the fibula behind the tibia, making closed reduction inherently difficult. Their subtle radiographic appearance often delays diagnosis. This case highlights the diagnostic challenges and operative considerations associated with this uncommon and frequently irreducible injury pattern.

CASE REPORT: A 34-year-old man presented after a fall with a posterior malleolus fracture, distal fibular fracture, and tibiotalar dislocation. Closed reduction improved alignment, but persistent mortise asymmetry prompted computed tomography (CT) imaging, which raised suspicion for posterior fibular entrapment. The patient subsequently underwent operative exploration and open reduction with internal fixation.

RESULTS

Intraoperative findings confirmed posterior fibular incarceration, comminution, and complete syndesmotic disruption. Anatomic reduction was achieved with plate fixation and syndesmotic stabilization. The patient recovered uneventfully and progressed to weight-bearing without complication.

CONCLUSION

Bosworth fracture-dislocations require a high index of suspicion, particularly when closed reduction fails or mortise asymmetry persists. CT imaging is essential for identifying posterior fibular entrapment, and early operative management is critical to restoring alignment and preventing long-term morbidity. This case reinforces the importance of timely recognition and surgical intervention in achieving favorable outcomes.

LEVEL OF EVIDENCE: Level V - case report.