Bosworth fracture treated with immediate open reduction and internal fixation 6 hours after injury: A case report

Ankle fractures are among the most common fractures from orthopedic injuries. Bosworth fracture-a rare ankle fracture-occurs when the proximal fibular fragment gets impacted behind the posterior tubercle of the distal tibia. Given the rarity of the Bosworth fracture, delayed management of or neglect in reducing the entrapped proximal fibula behind the posterior tibia may lead to catastrophic complications, including compartment syndrome, early arthritic changes, and residual ankle pain. Here, we present a case of this rare type of ankle injury that was treated with immediate open reduction and internal fixation (ORIF) 6 hours after injury and review the previous literature on ankle injuries. The proximal fibula was levered out from behind the tibia with posterior traction, and the proximal fibular fragment was internally rotated gently to minimize the damage to the surrounding soft tissues. Immediate ORIF performed within 6 hours resulted in good surgical outcomes in our case.