HOT TOPIC: Surgical Treatment of Posterior Malleolar and Syndesmotic Ankle Injuries

Abstract

In fractures and/or ligamentous injuries about the ankle, it has long been known that even a small change in the position of the talus can cause a significant decrease in tibiotalar contact area. It is also generally accepted that posterior malleolus fractures that incorporate more than 25% of the distal tibial articular surface can lead to posterior subluxation of the talus. Smaller fragments may also lead to talar instability. Because the posterior inferior tibiofibular ligament inserts on the posterior malleolus, fractures to this region of the tibia will render the ligament incompetent. Repair of the syndesmotic complex can be accomplished via syndesmotic screw fixation or reduction and fixation of the posterior malleolus fragment. Both in vitro and in vivo studies have shown, however, that reconstruction of the posterior malleolus provides equal or greater syndesmotic stability, as well as a more anatomic reconstruction of the tibial incisura, than does screw fixation. In this article, we review the pathophysiology, etiology, and diagnosis of posterior malleolus fractures, and provide a brief overview of the surgical technique for reduction and fixation of the posterior malleolar fragment.

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