Pathoanatomy of Posterior Malleolar Fractures of the Ankle

Abstract

The fracture lines associated with posterior malleolar fractures appear to be highly variable. A large fragment extending to the medial malleolus existed in almost 20% of the posterior malleolar fractures in the current study, and some fragments involved almost the entire medial malleolus. Because of the great variation in fracture configurations, preoperative use of computed tomography may be justified. The information obtained from this study will be helpful for conducting basic research of this condition and for determining appropriate surgical approaches.

The effect of minimally displaced posterior malleolar fractures on decision making in minimally displaced lateral malleolus fractures

“…To the best of our knowledge, surgical indications for this type of malleolar injury have not been clearly defined until now, and preferences among an international community of orthopaedic surgeons have not previously been presented. Whereas some investigators recommend nonoperative treatment for minimally displaced fractures [2,3,21], others suggest internal fixation of the lateral malleolus fragment [7,8] and then fixation of the posterior malleolus fragment only if reduction of this fragment was not achieved following lateral malleolus fixation. Our findings suggest that in this scenario of ankle fractures, the majority of orthopaedic surgeons prefer internal fixation of both fragments.…”

“…When there is minimal displacement, it is acceptable to treat lateral malleolus fractures nonoperatively [8,9,14,16]. However, fractures of the posterior malleolus, which usually occur in combination with lateral malleolus fractures [20,21], may alter treatment decisions even when there is minimal displacement of the fragments.…”

“…However, fractures of the posterior malleolus, which usually occur in combination with lateral malleolus fractures [20,21], may alter treatment decisions even when there is minimal displacement of the fragments. Although there is still debate whether the primary role of the posterior malleolus is related to peak stress distribution or to tibiotalar stability [7,19], indications for operative intervention in cases of posterior malleolus fractures are frequently based on fragment size [7,8,10]. Accordingly, 97 % of surgeons preferred operative management for posterior malleolus fractures in one study when >50 % of the articular surface was involved [8].…”

“…Although there is still debate whether the primary role of the posterior malleolus is related to peak stress distribution or to tibiotalar stability [7,19], indications for operative intervention in cases of posterior malleolus fractures are frequently based on fragment size [7,8,10]. Accordingly, 97 % of surgeons preferred operative management for posterior malleolus fractures in one study when >50 % of the articular surface was involved [8]. Yet, common combinations of minimally displaced lateral malleolus fractures with minimally displaced posterior malleolus fractures that involve <50 % of the articular surface increase the uncertainty regarding preferred treatment.…”

High Association of Posterior Malleolus Fractures with Spiral Distal Tibial Fractures

“…However, when associated with a tibial shaft fracture, there are no studies describing the outcomes of these fractures managed operatively or nonoperatively. Because of variation in morphologic features of posterior malleolus fractures, using CT may be justified [8]. Distal and presumed extraarticular tibial fractures are treated routinely by intramedullary nailing to reduce and stabilize the metaphyseal fracture.…”