Addressing Posterior Malleolar Ankle Fractures

Author(s): 
Nicholas Todd, DPM, AACFAS, Meagan Jennings, DPM, FACFAS, Shannon Rush, DPM, FACFAS, Ryan Wood, DPM, and Richard Jensen, DPM, FACFAS

   Postoperative care included six weeks of non-weightbearing. She began active range of motion at week four (only dorsiflexion and plantarflexion). At week six, we obtained a CT scan to ensure union. At four months, the patient began light jogging and was back to full active duty at six months. There was some residual numbness along the course of the sural nerve for eight months following surgery. These symptoms began to resolve after a year.

In Conclusion

Ankle fractures are a common injury and present in a variety of forms. The common mistake made by foot and ankle surgeons is treating these injuries in a dogmatic fashion. Posterior malleolar fractures are challenging. Even within this fracture group, there are a variety of subclasses. Surgeons have established loose criteria for fixing these fractures and it is likely that many of these fractures are left untreated.

   Historically, surgeons have employed radiographic imaging to help determine treatment for posterior malleolar fractures. It is no longer acceptable to treat these fractures subjectively. In an era of evidence-based medicine, we feel that posterior malleolar fractures require a new “standard of care.”

   Similar to how we approach calcaneal fractures, we conclude that CT imaging is a necessity in surgical planning for the reduction of these fractures. Too often, the surgeon will fixate the posterior malleolar fracture with an indirect anterior to posterior technique. Although this reduction technique is easier, it leads to poor alignment. Surgeons can achieve anatomic reduction of these complicated fractures if they employ basic principles: proper imaging, complete understanding of surgical anatomy and a solid understanding of internal fixation principles.

   Surgeons will always debate different approaches for fracture reduction. One thing that is not debatable is the importance of proper anatomic reduction with regard to intra-articular fractures. We believe this cannot occur consistently in posterior malleolar fractures without a well planned out posterior approach.

   Dr. Todd is an Associate of the American College of Foot and Ankle Surgeons. He is affiliated with the Department of Podiatry at the Palo Alto Medical Foundation in Mountain View, Calif.

   Dr. Jennings is affiliated with the Department of Orthopedics and Podiatry at the Palo Alto Medical Foundation in Mountain View, Calif. She is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Rush is affiliated with the Department of Orthopedics at the Palo Alto Medical Foundation in Mountain View, Calif. He is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Wood is affiliated with the Department of Podiatry at the Palo Alto Medical Foundation in Mountain View, Calif.

   Dr. Jensen is affiliated with the Department of Podiatry at the Palo Alto Medical Foundation in Mountain View, Calif. He is a Fellow of the American College of Foot and Ankle Surgeons.

Add new comment