This 2013 JAAOS review by Irwin et al. examines the anatomy, biomechanics, classification, and surgical decision-making for posterior malleolus fractures — a component of ankle fractures whose optimal management remains contested. It addresses whether and when to fix these fragments, surveying both biomechanical data and clinical outcome studies.
When you see a posterior malleolus fracture on ankle CT, don't anchor to the 25% size rule — assess displacement, articular impaction, syndesmotic stability, and fragment morphology (Haraguchi type), because fixation of any significantly displaced fragment restores syndesmotic stiffness better than screws alone and may improve long-term outcomes regardless of size.
The sural nerve is at risk in 83% of posterolateral approaches, so identify and protect it routinely.
This 2013 JAAOS review by Irwin et al. examines the anatomy, biomechanics, classification, and surgical decision-making for posterior malleolus fractures — a component of ankle fractures whose optimal management remains contested. It addresses whether and when to fix these fragments, surveying both biomechanical data and clinical outcome studies.
When you see a posterior malleolus fracture on ankle CT, don't anchor to the 25% size rule — assess displacement, articular impaction, syndesmotic stability, and fragment morphology (Haraguchi type), because fixation of any significantly displaced fragment restores syndesmotic stiffness better than screws alone and may improve long-term outcomes regardless of size.
The sural nerve is at risk in 83% of posterolateral approaches, so identify and protect it routinely.