Bosworth ankle injuries (BAIs) are a very rare ankle dislocation with bi or trimalleolar fractures and associated with a fixed posterior dislocation of the fibula fragment that becomes trapped behind the posterior tibial tubercle. The nature of the injury was first described by the American orthopedic surgeon David M. Bosworth (1897–1979) in 1947 in a series of 5 patients.
It is caused by severe external rotation of the ankle with the ankle remaining externally rotated after the injury. This externally rotated position of the ankle can make X-ray interpretation difficult, leading to a wrong diagnosis and maybe inappropriate treatment. On a CT scan, the fibula will be displaced behind the posterior edge of the fibular notch and trapped between the distal tibia and the displaced posterior malleolar fragment.
Attempts at closed reduction often fail due to the fixed position of the fibula behind the distal tibia. Open reduction is the recommended treatment.
Reference:
Bosworth, DM: “Fracture-Dislocation of the Ankle with Fixed Displacement of the Fibula behind the Tibia”. J Bone Joint Surg. 29: 130–135; Jan, 1947.
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