INTRODUCTION: Compartment 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 METHODS: Here, 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. RESULTS: At 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%. CONCLUSIONS: Given 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.

Department of Orthopaedics 1st Faculty of Medicine Charles University and Central Military Hospital U Vojenské Nemocnice 1200 Prague 6 169 02 Czech Republic

Department of Surgery of 1st Faculty of Medicine Charles University and Thomayer Hospital Videnska 800 Prague 4 140 00 Czech Republic

University Center of Orthopaedics Trauma and Plastic Surgery University Hospital Carl Gustav Carus Dresden Fetscherstrasse 74 01307 Dresden Germany

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