Successful closed reduction of Bosworth ankle fracture-dislocation: A case report

Bosworth fracture-dislocation presents a challenge in ankle joint injuries owing to its irreducible nature, requiring open reduction in most cases. Reports on successful outcomes following closed reduction are limited, necessitating exploration into alternative treatment approaches. Herein, we report a case of Bosworth fracture-dislocation in a 39-year-old man, with radiographic evidence of posterior displacement of the distal portion of the proximal fibular fragment incarcerated behind the tibia. Closed reduction was attempted with the patient's knee flexed at 90°, employing gradual traction, internal foot rotation, and counterforce provided by an assistant. The procedure resulted in a successful reduction, highlighting the potential of closed reduction in managing Bosworth fracture-dislocations. This underscores the importance of considering closed reduction as an initial treatment option before surgery, particularly given the injury mechanism. However, repeated attempts for closed reduction should be avoided to prevent iatrogenic soft tissue damage, which could result in postoperative wound complications and compartment syndrome. This case demonstrates the feasibility of closed reduction in Bosworth fracture-dislocation cases, offering a potential avenue to delay surgical intervention until the resolution of limb swelling and improve patient outcomes.