Bosworth fracture

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Bosworth fracture

Bosworth fracture is a historical term that describes a type of ankle injury, where there is a broken bone in a pushed out of place ankle, caused by extreme twisting of the foot.[1][2] It presents with a swollen ankle with varying degrees of pain depending on severity, and may appear deformed.[2] It is a break of the distal fibula with an associated fixed posterior dislocation of the proximal fibular fragment which becomes trapped behind the posterior tibial tubercle.[2]

The injury is caused by severe external rotation of the ankle.[3] The ankle remains externally rotated after the injury, making interpretation of X-rays difficult which can lead to misdiagnosis and incorrect treatment.[4] The injury is most commonly treated by open reduction internal fixation as closed reduction is made difficult by the entrapment of the fibula behind the tibia.[3]

The entrapment of an intact fibula behind the tibia was described by Ashhurst and Bromer in 1922, who attributed the description of the mechanism of injury to Huguier's 1848 publication.[5] The injury involving fibular fracture with posterior dislocation was described by David M. Bosworth in 1947.[6]

It is rare.[3]


  1. Hunter, Tim B.; Peltier, Leonard F.; Lund, Pamela J. (1 May 2000). "Radiologic History Exhibit". RadioGraphics. pp. 819–836. doi:10.1148/radiographics.20.3.g00ma20819. Archived from the original on 16 September 2022. Retrieved 16 September 2022.
  2. 2.0 2.1 2.2 Natrajan, M. V. (2018). "20. Injuries of the ankle and foot". Natarajan’s Textbook of Orthopaedics & Traumatology (8th ed.). New Delhi: Wolters Kluwer. p. 335. ISBN 978-93-86691-49-1. Archived from the original on 2022-09-20. Retrieved 2022-09-14.
  3. 3.0 3.1 3.2 Perry, CR; Rice S; Rao A; Burdge R. (Oct 1983). "Posterior fracture-dislocation of the distal part of the fibula. Mechanism and staging of injury". J Bone Joint Surg Am. 65 (8): 1149–57. doi:10.2106/00004623-198365080-00016. PMID 6630259. Archived from the original on 2010-11-01. Retrieved 2009-10-10.
  4. Hoblitzell, RM; Ebraheim NA; Merritt T; Jackson WT. (1990). "Bosworth fracture-dislocation of the ankle. A case report and review of the literature". Clin Orthop Relat Res (255): 257–62. PMID 2112075.
  5. Ashhurst, APC; Bromer RS (1922). "Classification and Mechanism of Fractures of the Leg Bones Involving the Ankle. Based on a Study of Three Hundred Cases from the Episcopal Hospital". Arch. Surg. 4: 51–129. doi:10.1001/archsurg.1922.01110100060003. Archived from the original on 2019-06-27. Retrieved 2020-10-19.
  6. Bosworth, DM (Jan 1947). "Fracture-Dislocation of the Ankle with Fixed Displacement of the Fibula behind the Tibia". J Bone Joint Surg. 29: 130–135.

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