Posterior Malleolar Fractures in Trimalleolar Ankle Injuries: Anatomy, Classification, Diagnosis, and Management; A Narrative Review

Abstract

Background: The ankle joint is a modified hinge joint. It is a complex joint, as three bones and many ligaments share in its formation. Posterior malleolar fractures may affect articular congruity, syndesmotic stability, and ankle function.

Aim: To review the anatomy and biomechanics of the ankle joint, the classification and diagnosis of posterior malleolar fractures, and the available nonoperative and operative methods of management.

Conclusion: Plain radiographs remain the initial radiological examination, while computed tomography provides a better understanding of the size, morphology, and orientation of the posterior malleolar fragment. Treatment may be nonoperative or operative. Accurate reduction and stable fixation are required to restore ankle stability and reduce the risk of postoperative complications.