Citation: Journal of Foot & Ankle Surgery. 2015 Jun 19
Author: Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S
Abstract: Posterior malleolar fractures are relatively common and usually result from
rotational ankle injuries. Although treatment of associated lateral and medial
structures is well established, several controversies exist in the management of
posterior malleolus fractures. We performed a systematic review of the current
published data with regard to the diagnosis, management, and prognosis of
posterior malleolus fractures. A total of 33 studies (8 biomechanical and 25
clinical) with >950 patients were reviewed. The outcome of ankle fractures
with posterior malleolar involvement was poor; however, the evidence was not
enough to prove that the size of the posterior malleolus affects the outcome.
Significant heterogeneity was noted in the cutoff size of the posterior
malleolar fragment in determining management. The outcome was related to other
factors, such as fracture displacement, congruency of the articular surface, and
residual tibiotalar subluxation. Indirect evidence showed that large fracture
fragments were associated with fracture dislocations and ankle instability and,
thus, might require surgical fixation. We have concluded that the evidence to
prove that the size of the posterior malleolar affects the outcome of ankle
fractures is not enough, and the decision to treat these fractures should be
determined by other factors, as stated previously.
Link to PubMed record
