![]() It was based on experimental, clinical and radiological findings with the fracture type depending on parameters such as the position of the foot and the direction of the force at the time of injury. The most commonly accepted classification is the generic one made by Lauge-Hansen in 1984. The consideration of both classifications is desirable, as a surgeon should be able to establish a correlation between the fracture, mechanism of an injury and an optimal treatment method. The most common classifications are those of Lauge-Hansen and Danis-Weber. Therefore, posterolateral approach is gaining popularity due to adequate visualization and accurate anatomic reduction.ĭecades of research into ankle fracture provides multiple classifications focusing on the mechanism of injury along with correlation with the pattern of the fractures. Although minimally invasive, the anterior incision has limited visualization of the fragments further hindering a proper anatomic reduction leading to poor prognosis. Traditionally, method of posterior malleolus fractures fixation is indirect reduction and an anteroposterior screw. The literature describes various approaches for fixation of posterior malleolus. The recent advancement has evolved from simple closed reduction and casting, to open reduction and internal fixation. Inadequate reduction of ankle fracture leads to early osteoarthritis, resulting in pain and loss of function of the ankle joint. On the contrary, the need for fixation of fragments <25% has not yet been clarified. The standard intervention for posterior malleolus fracture fixation involving >25% - 35% of the articular surface of distal tibia should be internally fixed. No consensus has provided the best methodology for reduction and stabilizes the posterior tibial malleolus. Still, fixation of the posterior malleolus fractures remains an area of controversy in orthopedic surgery. Recent literature shows a changing tendency towards the anatomical correction of the joint, based on the presence of intra-articular step-off rather than the size of the posterior fragment. Some studies have shown the importance of PM on the stability of tibiofibular syndesmosis (TFS) and the ankle joint. PM fractures are generally neglected due to the spontaneous reduction of these fragments after open reduction of the lateral malleolus through ligamentotaxis done by the posterior-inferior tibiofibular ligament (PITFL). Henderson introduced the term trimalleolus fracture in 1932. However, in 1836 this type of fracture had been previously described by Adams. In 1915, Cotton described a new type of ankle fracture eventually named after him which was a bimalleolus fracture along with a fracture of PM. Radiological study of the posterior tibial rim fragment was initially studied by Chaput in 1907 followed by Destot who further introduced the term “malle’ole poste’rieure” (posterior malleolus ) in 1911. It is also defined as the posterior malleolus fracture or Volkmann’s fracture. Typical rotational mechanism of the ankle fracture may lead to the rupture of the posterior inferior tibiofibular ligament (PITFL) or create an avulsion fracture of the posterior tibial margin. Usually it results from rotation of ankle and accompanying typically with fractures of single or both malleoli. Among which about 7% to 44% are accompanied by posterior malleolus fracture, which are rarely seen alone. Nowadays, posterolateral approach is gaining the popularity due to adequate visualization and accurate anatomic reduction.Īnkle fractures are injuries with an annual occurrence of approximately 100/ 100,000 person yearly. Operative management goals to reach a stable ankle with maximal function, decrease the risk of post-traumatic degenerative changes, and diminish the risk of complication. Previously, the most common method of fixation of the posterior malleolus is by indirect reduction and antero-posterior screws, it is minimally invasive, the anterior incision does not allow satisfactory visualization of the fragment, so good anatomical reduction is difficult to achieve thorough this approach. Several approaches and methods for fixation of posterior malleolus have been defined in the literature. Further attention is required for the reduction and fixation of fractures involving posterior malleolus. Most orthopedic surgeons recommend fixing the posterior malleolus fracture if it is larger than 25% to 33% of the distal articular surface. Therefore, fracture of posterior malleolus is striking subject of study among orthopedic surgeons. For the management of posterior malleolus fractures, more studies are still required, though it is already well-recognized for medial and lateral structure. Posterior malleolus fractures are quite common and usually result from rotational ankle injuries. ![]()
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