Posterior Malleolus Fracture – Maybe a Difficult One to Treat

Ankle fractures are one of the most common forms of fractures that occur in the leg. Such fractures most commonly occur during sports activities, uneven foot placement while walking, or automobile accidents.

Our ankle is made of three bones including the tibia and fibula (bones of the leg) and talus (the foot bone). The combination formed by these three bones gives rise to a hinge-type joint that helps in dorsiflexion and planta reflection of the foot.

When the fracture occurs, the seriousness of the condition determines whether it is easy to fix or not. In this post, we are going to discuss a fracture that could be a difficult one to fix. The condition we are talking about is posterior malleolus fracture.

What is Posterior Malleolus Fracture?

The location of the posterior malleolus is on the lower backside of the tibia and when the bone break occurs in this region, the condition is known as posterior malleolus fracture. The reason why such a fracture could be a difficult one for the orthopedist to treat is that the fracture pattern is most commonly irregular. The fracture could result in multiple fragments of bone and sometimes, the diagnosis of such condition could also be difficult.

Only around 1 percent of the ankle fractures are reported as isolated posterior malleolus fractures. In the rest of the cases, medial and lateral malleolus breaks are also seen. Such conditions are termed as trimalleolar fracture, where all three bone structures are involved (lateral & medial malleolus and distal posterior of the tibia). Trimalleolar fractures are serious and may also involve ankle dislocation and ligament damage.

The Diagnosis

As we have discussed above that posterior malleolus fractures could be difficult to diagnose thus, in suspected cases, a CT scan is preferred over X-ray and MRI. A CT scan will help the surgeon easily identify how many bone fragments are there and where the major one is located. The location of the major fragment is important because the fixation procedure will be focused at that point only.

Treatment of Posterior Malleolus Fracture

Posterior malleolus fractures often require surgery for the fixation of bone fragments in their natural anatomical position. Most surgeons also recommend surgery when the fracture causes any instability in the ankle joint.

During surgery, when the incision is made at the back of the ankle, the surgeon would be able to reposition bone fragments and hold them right in their place using orthopedic implants. Some of the most commonly used trauma implants for posterior malleolus fracture are locking plates and screws, orthopedic locking compression plates, and bone screws.

The application of such orthopedic devices ensures correct positioning of all fragments and proper healing of the fracture.

The Bottom Line

The location of the posterior malleolus in our ankle makes it difficult to diagnose and/or treat posterior malleolus fracture. Another reason why surgeons may find such fractures to fix is that most often they occur as a trimalleolar fracture. This is why a CT scan is preferred in such conditions instead of an X-ray to better understand the anatomy of the fracture.

Once the surgery is performed successfully, bed rest for a specific time period is suggested along with rehabilitation. This post is focused on telling what posterior malleolus fracture is and why it may be difficult for surgeons to diagnose & treat. We hope that you must have got an idea of why this is so.

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