This video discusses treatment considerations for posterior malleolus ankle fractures. A brief overview of multiple treatment options are discussed for varying fracture patterns. A detailed technique video is included, which demonstrates treatment of a trimalleolar ankle fracture variant with separate medial and lateral posterior malleolus components. The procedure is performed in prone position with utilization of a posterior lateral approach and a limited posterior medial approach. A favorable clinical and radiographic outcome is shown at six month follow up.