Posterior Malleolar Fractures

Posterior malleolar fractures are a common component of ankle fractures. Between 7 and 44% of all ankle fractures involve the posterior malleolus (1). This type of fracture often arises from rotational injury and rarely occurs in isolation. The morphology of the fracture can be variable. A secondary type of posterior malleolar fracture is the posterior pilon variant. This involves a majority of the posterior lip and is usually the result of a combined rotational and axial load injury. Currently there is no consensus regarding the minimum size of the fracture that requires fixation. It is generally accepted that posterior malleolar fractures tend to have worse outcomes. The recent literature has demonstrated improved anatomic reduction with fixation of a posterior malleolar fracture. There is an increasing trend to fixate these fractures when appropriate.