# Posterior Malleolar Fractures: From the "Forgotten Fragment" to Modern Concepts in Management

## TL;DR

This paper reviews the modern understanding and treatment of posterior malleolar fractures, emphasizing the role of CT scans and the importance of fragment morphology and joint stability.

## Contribution

The paper provides updated insights into the management of posterior malleolar fractures, moving beyond size-based approaches to consider fragment morphology and joint integrity.

## Key findings

- CT scanning has improved the understanding of posterior malleolar fractures by revealing fragment morphology and articular involvement.
- Treatment options vary from conservative to operative management based on fracture complexity and joint stability.
- Operative management remains controversial among orthopaedic surgeons for complex posterior malleolar fractures.

## Abstract

Posterior malleolar fractures (PMFs) affect ankle stability and patient prognosis. The posterior malleolus (PM) provides an articular surface, syndesmotic stability, and tibiotalar joint stability. Computed tomography (CT) scanning has changed the practice from size-based management to understanding the bigger picture, which includes considering fragment morphology, articular involvement, and syndesmotic stability. Treatment options range from conservative management in specific populations and fracture patterns to operative management for complex fractures that affect ankle joint integrity. Operative management options are controversial among orthopaedic surgeons. This focused review examines the anatomy, diagnosis, and various management strategies for PMFs.