The treatment of posterior malleolus fractures has traditionally been based on the size of the fracture fragment. Biomechanical evidence does suggest that larger posterior malleolar fragments can alter the load transmission through the tibiotalar joint. In trimalleolar fractures with smaller posterior malleolus fractures, fixation of the posterior malleolar fragment has been suggested as an alternative to the gold standard practice of fixing the fibular fracture first, then stressing the syndesmosis and adding transsyndesmotic fixation if necessary. This paper reviews the rationale for posterior malleolus fracture fixation based on fragment size and based on syndesmotic instability. The technique of posterior malleolar fixation is also reviewed.
*Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Orthopaedic Trauma Division, Bronx, NY
†Department of Orthopaedic Surgery, Louisiana State University, Baton Rouge, LA
R.Z.—Consultant for Smith & Nephew, Bioventis, Cardinal Health. The remaining authors declare that they have nothing to disclose.
For reprint requests, or additional information and guidance on the techniques described in the article, please contact Mani Kahn, MD, MPH, at or by mail at Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Orthopaedic Trauma Division, Bronx, NY. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques.