This retrospective cohort study applies the Mason and Molloy CT-based classification of posterior malleolar ankle fractures to a prospective treatment algorithm, asking whether fracture-type-specific surgical management — varying both the approach and fixation strategy — produces better functional outcomes than traditional one-size-fits-all treatment.
When you see a posterior malleolar fracture on plain films, get a CT before planning surgery — the Mason and Molloy type dictates both your approach (posterolateral for 2A, posteromedial for 3, combined for 2B) and whether you even fix the fragment directly (type 1 gets syndesmotic fixation only).
Treating all posterior malleolar fractures the same way, or defaulting to indirect anterior-to-posterior screws, leaves roughly 20 OMAS points on the table compared to a classification-driven direct fixation strategy.
This retrospective cohort study applies the Mason and Molloy CT-based classification of posterior malleolar ankle fractures to a prospective treatment algorithm, asking whether fracture-type-specific surgical management — varying both the approach and fixation strategy — produces better functional outcomes than traditional one-size-fits-all treatment.
When you see a posterior malleolar fracture on plain films, get a CT before planning surgery — the Mason and Molloy type dictates both your approach (posterolateral for 2A, posteromedial for 3, combined for 2B) and whether you even fix the fragment directly (type 1 gets syndesmotic fixation only).
Treating all posterior malleolar fractures the same way, or defaulting to indirect anterior-to-posterior screws, leaves roughly 20 OMAS points on the table compared to a classification-driven direct fixation strategy.