Abstract
Fifty percent of ankle fractures have posterior malleolar components. The morphology of the component can vary and it is controversial which fractures require fixation. Unfortunately, failure to identify or adequately fix posterior malleolar fractures leads to an incongruent tibiotalar joint and the need for complex revision surgery. The following chapter will review which posterior malleolar fractures require fixation and how to safely accomplish this while limiting complications when working around previous ankle incisions. The ultimate goal is to provide a stable and congruent tibiotalar joint.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Rammelt S, Bartoníček J. Posterior malleolar fractures. JBJS Rev. 2020;8(8):e19.00207.
Jaskulka RA, Ittner G, Schedl R. Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. J Trauma Inj Infect Crit Care. 1989;29(11):1565–70.
Tejwani NC, Pahk B, Egol KA. Effect of posterior malleolus fracture on outcome after unstable ankle fracture. J Trauma Inj Infect Crit Care. 2010;69(3):666–9.
Odak S, Ahluwalia R, Unnikrishnan P, et al. Management of posterior malleolar fractures: a systematic review. J Foot Ankle Surg. 2016;55(1):140–5.
Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Jt Surg Ser A. 2006;88(5):1085–92.
Bartoníček J, Rammelt S, Kostlivý K, et al. Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg. 2015;135(4):505–16.
Harper MC. Posterior instability of the Talus: an anatomic evaluation. Foot Ankle Int. 1989;10(1):36–9.
Raasch WG, Larkin JJ, Draganich LE. Assessment of the posterior malleolus as a restraint to posterior subluxation of the ankle. J Bone Jt Surg Ser A. 1992;74(8):1201–6.
Hartford JM, Gorczyca JT, McNamara JL, et al. Tibiotalar contact area: contribution of posterior malleolus and deltoid ligament. Clin Orthop Relat Res. 1995;320:182–7.
Fitzpatrick DC, Otto JK, McKinley TO, et al. Kinematic and contact stress analysis of posterior malleolus fractures of the ankle. J Orthop Trauma. 2004;18(5):271–8.
Evers J, Fischer M, Zderic I, et al. The role of a small posterior malleolar fragment in trimalleolar fractures: a biomechanical study. Bone Jt J. 2018;100-B(1):95–100.
Gardner MJ, Brodsky A, Briggs SM, et al. Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res. 2006;447:165–71.
Heim D, Niederhauser K, Simbrey N. The Volkmann dogma: a retrospective, long-term, single-center study. Eur J Trauma Emerg Surg. 2010;36(6):515–9.
Rammelt S, Bartoníček J. Posterior malleolar fractures: a critical analysis review. JBJS Rev. 2020;8(8):e19.00207.
Langenhuijsen JF, Heetveld MJ, Ultee JM, et al. Results of ankle fractures with involvement of the posterior tibial margin. J Trauma. 2002;53(1):55–60.
Ebraheim NA, Mekhail AO, Haman SP. External rotation-lateral view of the ankle in the assessment of the posterior malleolus. Foot Ankle Int. 1999;20(6):379–83.
Yao L, Zhang W, Yang G, et al. Morphologic characteristics of the posterior malleolus fragment: a 3-D computer tomography based study. Arch Orthop Trauma Surg. 2014;134(3):389–94.
Donohoe S, Alluri RK, Hill JR, et al. Impact of computed tomography on operative planning for ankle fractures involving the posterior malleolus. Foot Ankle Int. 2017;38(12):1337–42.
Hartwich K, Lorente Gomez A, Pyrc J, et al. Biomechanical analysis of stability of posterior antiglide plating in osteoporotic pronation abduction ankle fracture model with posterior tibial fragment. Foot Ankle Int. 2017;38(1):58–65.
De Vries JS, Wijgman AJ, Sierevelt IN, et al. Long-term results of ankle fractures with a posterior malleolar fragment. J Foot Ankle Surg. 2005;44(3):211–7.
Tornetta P, Ricci W, Nork S, et al. The posterolateral approach to the tibia for displaced posterior malleolar injuries. J Orthop Trauma. 2011;25(2):123–6.
Zhong S, Shen L, Zhao JG, et al. Comparison of posteromedial versus posterolateral approach for posterior malleolus fixation in trimalleolar ankle fractures. Orthop Surg. 2017;9(1):69–76.
Howard JL, Agel J, Barei DP, et al. A prospective study evaluating incision placement and wound healing for tibial plafond fractures. J Orthop Trauma. 2008;22(5):299–305.
Taylor GI, Pan WR. Angiosomes of the leg: anatomic study and clinical implications. Plast Reconstr Surg. 1998;102(3):599–616.
Taylor GI. The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg. 2003;30(3):331–42.
Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40(2):113–41.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ryan, S.P., Pagani, N.R. (2024). Posterior Malleolar Ankle Failed Fixation. In: Giannoudis, P.V., Tornetta III, P. (eds) Failed Fracture Fixation. Springer, Cham. https://doi.org/10.1007/978-3-031-39692-2_40
Download citation
DOI: https://doi.org/10.1007/978-3-031-39692-2_40
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-39691-5
Online ISBN: 978-3-031-39692-2
eBook Packages: MedicineMedicine (R0)