Management of posterior Malleolus fracture

Abstract

Ankle fractures are among the most common lower extremity injuries. They are requiring hospital admission occur at an annual incidence rate of 171 per 100,000 person-years, increasing annually particularly in elderly women. In men and women, 39% and 57% of such ankle fractures, respec¬tively, have been reported to be bi- or trimalleolar frac¬tures, while other series report at least 7% of ankle fractures to include the posterior malleolus. The isolated posterior malleolar fracture is an uncommon occurrence in which the patient presents to the physician with minimal complaints. It can easily be overlooked on the physical examination if the posterior malleolar area is not palpated because of a low index of suspicion on the examiner’s part. The radiological examination may also be misleading secondary to overlap of the tibia and fibula. If clinically indicated, the “poor” lateral should be obtained. If these injuries are not discovered, or involve more than 25% of the articular surface, there is a high incidence of complications, especially if there is displacement. Posterior malleolar fractures are heterogeneous in morphology, and CT is useful to define fracture patterns. Fixation of posterior malleolus fractures in the setting of rotational ankle injuries has certain benefits, including restoring articular congruity, increasing rotatory ankle stability, and providing a bony restraint against posterior translation.