Ankle Fractures Continued

Intraop Arthroscopic Pic of Intra-articular Medial Malleolus/Distal Tibia Fracture. The Fracture line can be seen at the tibia at the top of the pic during ankle joint arthroscopic assisted minimal invasive percutaneous screw fixation.

3. Posterior Malleolar Fracture

Trimalleolar fractures involve fracture of the medial and lateral malleoli along with a fracture of the posterior lip of the tibial plafond; (posterior malleolar fracture). Fracture results from avulsion by the posterior tibiofibular ligament at its site of attachment to the tibia. The irregularity in the tibial articular surface of the tibia is brought against the weightbearing surface of the talus and with motion and weightbearing severe DJD develops.

Indications for surgery:

  • 25% of the posterior articular surface is involved;
  • Fragment must have a tibial articular surface that is large enough to provide a stable weightbearing surface;
  • Fracture is displaced more than 2 mm;
  • Ankle fracture dislocation with posterior malleolar fracture;
  • Posterior subluxation of the talus;
  • Even the slightest posterior subluxation of the talus on the articular surface of the tibia is not acceptable;
  • If fracture prevents reduction of the fibula;
  • Valgus tilt of the talus in post-reduction film may be a relative indication.


Posterior Malleolar Fractures