Posterior Malleolar Fractures: Changing Concepts and Recent Developments

• Published in: Foot and ankle clinics Vol. 22; no. 1; pp. 125 - 145
• Main Authors: Bartoníček, Jan, Rammelt, Stefan, Tuček, Michal
• Format: Journal Article
• Language: English
• Published: United States 01-03-2017
• Subjects: Ankle Fractures - diagnostic imaging; Ankle Fractures - physiopathology; Ankle Fractures - surgery; Biomechanical Phenomena; Fracture Dislocation - diagnostic imaging; Fracture Dislocation - physiopathology; Fracture Dislocation - surgery; Fracture Fixation; Humans; Tomography, X-Ray Computed; Ankle fractures; Posterior malleolus; Trimalleolar fractures; Posterior approaches; Classification
• ISSN: 1558-1934
• DOI: 10.1016/j.fcl.2016.09.009

Injuries to the posterior malleolus are of prognostic relevance in ankle fracture-dislocations. The three-dimensional outline of the fragments as reflected by computed tomography classification, involvement of the fibular notch, and the presence of intercalary fragments seem to be of greater therapeutic relevance than the size of the fragment and amount of the articular surface involved. Operative treatment aims at reconstruction of the posterior tibial plafond, the fibular notch, and the integrity of the posterior inferior tibiofibular syndesmosis. Direct open reduction and fixation of posterior malleolus fragments via posterior approaches is biomechanically more stable than indirect reduction and anteroposterior screw fixation.