Trimalleolar Fractures


Trimalleolar fractures involve fracture of the medial malleolus and  fibula, along with fracture of the posterior lip of the articular surface of the tibia.  The medial malleolus may remain intact with a tear of the deltoid ligament occurring instead of a malleolar fracture. A majority of the time, these fractures require open reduction internal fixation (ORIF) due to instability and displacement.  Open reduction internal fixation is recommended when:

  • 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;
  • There is posterior subluxation of the talus;
  • Even the slightest posterior subluxation of the talus on the articular surface of the tibia is not acceptable;
  • If the fracture prevents reduction of the fibula.

Preop and Postop Pics of Trimalleolar Fracture


Pre and postop Trimalleolar Fracture without FIxation of Posterior Malleolus

Postop (lateral and medial malleolus are fixated but the posterior malleolus is nondisplaced so fixation is not performed in this instance)

Pre and Postop Displaced Unstable Trimalleolar Fracture ORIF

Pre and Postop Displaced Unstable Trimalleolar Fracture ORIF

Pre and Post Trimalleolar Fracture S/P ORIF with Fixation Posterior Malleolus


Dislocated Trimalleolar Fracture Before and After Closed Reduction (Prior to Surgical Fixation)


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