• Jan Bartoníček, Stefan Rammelt, and Karel Kostlivý.
• Department of Orthopaedics, First Faculty of Medicine, Charles University and Central Military Hospital, U Vojenské Nemocnice 1200, Prague 6, 169 02, Czech Republic.
• Arch Orthop Trauma Surg. 2022 Jul 1; 142 (7): 1435-1441.

IntroductionCompartment syndrome (CS) is exceedingly rare in ankle fractures. However, the risk of CS development seems to be increased in the presence of a Bosworth fracture-dislocation (BF), a rare variant of locked dislocation of the fibula behind the tibia.Materials And MethodsHere, we report the case of a 39-year old man with delayed diagnosis of CS after having sustained a BF and failed attempts on closed reduction. The patient developed a flexion contracture of the hallux necessitating secondary fusion.ResultsAt 3 years after the injury, the patient was capable of running, but had 10 degrees limitation of ankle dorsiflexion, persisting decreased sensation on the plantar surface and clawing of the lesser toes. A thorough review of the literature revealed nine cases of CS after 167 reported BF resulting in a calculated prevalence of 5.4%.ConclusionsGiven the extreme paucity of CS in malleolar fractures, CS in BF has a relatively high prevalence. Risk factors include severe dislocations, repeated attempts on closed reduction, and a long interval to definite surgery. A high index of suspicion is required because delayed diagnosis leads to lasting functional restrictions.© 2021. The Author(s).

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