A 1947 case series of five ankle fracture-dislocations in which the proximal fibular fragment became entrapped behind the posterolateral ridge of the tibia — a pattern Bosworth recognized had not been previously reported. The paper asks why closed reduction fails in these cases and what operative approach is required.
When you see an ankle fracture-dislocation that won't reduce closed — or where the lateral X-ray looks 'off' but is dismissed as a rotation artifact. Get a true lateral and look specifically for the proximal fibular fragment sitting behind the tibia.
If it's there, don't attempt another closed reduction: this is a Bosworth fracture and the interosseous membrane makes reduction mechanically impossible without a pry at open surgery.
A 1947 case series of five ankle fracture-dislocations in which the proximal fibular fragment became entrapped behind the posterolateral ridge of the tibia — a pattern Bosworth recognized had not been previously reported. The paper asks why closed reduction fails in these cases and what operative approach is required.
When you see an ankle fracture-dislocation that won't reduce closed — or where the lateral X-ray looks 'off' but is dismissed as a rotation artifact. Get a true lateral and look specifically for the proximal fibular fragment sitting behind the tibia.
If it's there, don't attempt another closed reduction: this is a Bosworth fracture and the interosseous membrane makes reduction mechanically impossible without a pry at open surgery.