Treatment of Posterior Malleolus Fractures


Posterior malleolus fractures may occur in isolation or, more commonly, in association with bimalleolar or trimalleolar fracture patterns. These fractures result from posterior tibiofibular ligament avulsion, or bony impaction from the talus. Isolated posterior malleolus fractures have also been reported to occur in conjunction with spiral tibial shaft fractures. Posterior malleolus fractures may be identified on standard AP, mortise, and lateral radiographs of the ankle; however, CT allows for better assessment of displacement and the location of fracture lines. Generally, nondisplaced fractures with less than 25% involvement of the articular surface may be treated nonsurgically with short-term immobilization followed by range-of-motion exercise and gradual return to weight bearing. Surgical options include minimally-invasive, percutaneous fixation, although formal open reduction and internal fixation using a posteromedial, posterolateral, or combined approach is often necessary.

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