The ankle joint is a complex junction of three bones known as the fibula, tibia, and talus. The tibia is commonly referred to as the shin bone, while the fibula is the thinner leg bone adjacent to it. The talus, meanwhile, is the bone situated between the tibia, fibula, and heel which forms the primary connection between the lower leg and foot and is vital for mobility and balance.
Because the ankle is vulnerable to twists and compression, the fracture of these bones is not uncommon and can sometimes be difficult to treat.
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Anatomy of an Ankle Fracture
When most people describe an ankle fracture, they generally mean it to involve lower parts of the tibia and/or fibula. Some fractures involve both bones; others affect only one. The fracture itself may take place on the bulbous ends of the bones known as the malleoli, which include:
Of these, the posterior malleolus is the structure least likely to be fractured on its own. Isolated breaks are rare, and, when they do happen, they tend to be difficult toreduce(reset) and fixate (stabilize).
Posterior Malleolus Fractures
Posterior malleolus fractures can be challenging to an orthopedist since the fracture pattern is often irregular. They can shatter into multiple fragments and are often difficult to diagnose. Moreover, there is little consensus on how best to stabilize the fracture once it has been reset.
In general, these injuries are described astibial plafond fractures(plafondreferring the part of the tibia where joint articulation occurs). And because the tissue is relatively thin there, it is not uncommon to have anopen fracture(one in which the skin is broken).
All told, isolated posterior malleolus fractures account for only around 1% of ankle fractures.
Treatment and Diagnosis
Because an isolated fracture of this sort is so rare, diagnoses are sometimes missed or inconclusive. If suspected, acomputed tomography (CT)scan is generally preferred over an X-ray orMRI. The CT scan allows the surgeon to clearly see how many fragments there are and helps determine where the major fragment is located. It will be this fragment where fixation efforts will be focused.
Surgery will often be required to ensure the fragments are correctly placed. With that being said, there remains controversy as to when it is most appropriate. Traditionally, surgeons have long recommended surgery if more than 25% of the malleoli is involved.
Things are slightly different now with most surgeons agreeing that the size of the fragment is not the critical factor. Instead, surgery should be performed if the posterior malleolus fracture causes any instability of the ankle joint, irrespective of the size or location of the fracture.
Generally speaking, the best way to reposition the bone is through an incision in the back of the ankle. This allows your surgeon to reposition the fragments and secure them with plates and screws. In some cases, the bone will not need to be repositioned, and the fragment can be secured without surgery.
Rehabilitation
Rehabilitationis similar to that used for other types of ankle fracture. Typically, surgeons will immobilize the ankle and allow the incisions to heal before initiating physical therapy. This is why postoperative care will often require the ankle to be non-weight-bearing for six weeks.
Though uncommon, in some cases, people may need to undergo surgery to have thesurgical hardware removedlater on down the road.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Podiatry Today.Treating complicated ankle fractures.American Academy of Orthopaedic Surgeons.Ankle fractures (broken ankle).Serbest S, Tiftikçi U, Tosun HB, Kesgin E, Karataş M.Isolated posterior malleolus fracture: a rare injury mechanism.Pan Afr Med J.2015;20:123. doi:10.11604/pamj.2015.20.123.6046Duan X, Kadakia AR.Operative treatment of posterior malleolar fractures.Open Orthop J. 2017;11:732-742. doi:10.2174/1874325001711010732Gibson PD, Bercik MJ, Ippolito JA, et al. The role of computed tomography in surgical planning for trimalleolar fracture. A survey of OTA members.Journal of Orthopaedic Trauma. 2017;31(4):e116-e120. doi:10.1097/BOT.0000000000000763Smeeing DPJ, Houwert RM, Kruyt MC, Hietbrink F.The isolated posterior malleolar fracture and syndesmotic instability: a case report and review of the literature.Int J Surg Case Rep. 2017;41:360-365. doi:10.1016/j.ijscr.2017.10.062Podiatry Today.Addressing posterior malleolar ankle fractures.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Podiatry Today.Treating complicated ankle fractures.American Academy of Orthopaedic Surgeons.Ankle fractures (broken ankle).Serbest S, Tiftikçi U, Tosun HB, Kesgin E, Karataş M.Isolated posterior malleolus fracture: a rare injury mechanism.Pan Afr Med J.2015;20:123. doi:10.11604/pamj.2015.20.123.6046Duan X, Kadakia AR.Operative treatment of posterior malleolar fractures.Open Orthop J. 2017;11:732-742. doi:10.2174/1874325001711010732Gibson PD, Bercik MJ, Ippolito JA, et al. The role of computed tomography in surgical planning for trimalleolar fracture. A survey of OTA members.Journal of Orthopaedic Trauma. 2017;31(4):e116-e120. doi:10.1097/BOT.0000000000000763Smeeing DPJ, Houwert RM, Kruyt MC, Hietbrink F.The isolated posterior malleolar fracture and syndesmotic instability: a case report and review of the literature.Int J Surg Case Rep. 2017;41:360-365. doi:10.1016/j.ijscr.2017.10.062Podiatry Today.Addressing posterior malleolar ankle fractures.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Podiatry Today.Treating complicated ankle fractures.American Academy of Orthopaedic Surgeons.Ankle fractures (broken ankle).Serbest S, Tiftikçi U, Tosun HB, Kesgin E, Karataş M.Isolated posterior malleolus fracture: a rare injury mechanism.Pan Afr Med J.2015;20:123. doi:10.11604/pamj.2015.20.123.6046Duan X, Kadakia AR.Operative treatment of posterior malleolar fractures.Open Orthop J. 2017;11:732-742. doi:10.2174/1874325001711010732Gibson PD, Bercik MJ, Ippolito JA, et al. The role of computed tomography in surgical planning for trimalleolar fracture. A survey of OTA members.Journal of Orthopaedic Trauma. 2017;31(4):e116-e120. doi:10.1097/BOT.0000000000000763Smeeing DPJ, Houwert RM, Kruyt MC, Hietbrink F.The isolated posterior malleolar fracture and syndesmotic instability: a case report and review of the literature.Int J Surg Case Rep. 2017;41:360-365. doi:10.1016/j.ijscr.2017.10.062Podiatry Today.Addressing posterior malleolar ankle fractures.
Podiatry Today.Treating complicated ankle fractures.
American Academy of Orthopaedic Surgeons.Ankle fractures (broken ankle).
Serbest S, Tiftikçi U, Tosun HB, Kesgin E, Karataş M.Isolated posterior malleolus fracture: a rare injury mechanism.Pan Afr Med J.2015;20:123. doi:10.11604/pamj.2015.20.123.6046
Duan X, Kadakia AR.Operative treatment of posterior malleolar fractures.Open Orthop J. 2017;11:732-742. doi:10.2174/1874325001711010732
Gibson PD, Bercik MJ, Ippolito JA, et al. The role of computed tomography in surgical planning for trimalleolar fracture. A survey of OTA members.Journal of Orthopaedic Trauma. 2017;31(4):e116-e120. doi:10.1097/BOT.0000000000000763
Smeeing DPJ, Houwert RM, Kruyt MC, Hietbrink F.The isolated posterior malleolar fracture and syndesmotic instability: a case report and review of the literature.Int J Surg Case Rep. 2017;41:360-365. doi:10.1016/j.ijscr.2017.10.062
Podiatry Today.Addressing posterior malleolar ankle fractures.
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