DIAGNOSIS AND MANAGEMENT OF POSTERIOR MALLEOLUS FRACTURES.

Authors
Panagiotis Mantzanas1,  Stefania Kanata2, Michail Michalos3, Panagiotis Papadopoulos4, Stamatios Tsamados5
1North West University Healthcare NHS Trust, London UK, 2University College London Hospitals NHS Foundation Trust, London UK, 3Imperial College Healthcare NHS Trust, London UK, 4Metropolitan Hospital, Piraeus GR,  5King’s College Hospital NHS Foundation Trust, London UK

Introduction
Posterior malleolus fractures are common, either as an element of bimalleolar/trimalleolar fracture or as isolated injuries. The functional outcomes following conservative or surgical management are often not satisfactory. Treatment algorithms have been established to standardise the management of these injuries.

Aim
This study aims to provide an update of the current diagnostic and treatment algorithms for the posterior malleolar fractures.

Material & Methods
Retrospective review of the literature suggests that plain radiographs are not reliable for the delineation of the morphology of the posterior malleolar fractures. Computed tomography (CT) is essential to characterize the fracture patterns, classify and treat accordingly.

Results
Functional outcomes are improved and risks of post-traumatic osteoarthritis is reduced following satisfactory anatomical reduction of the posterior malleolus fractures (no residual articular step-off post-operatively).

Conclusions
Traditional teaching of the indication for surgical management of posterior malleolus (fragment which comprises >25-33% of the articular surface) is outdated. Given the low reliability of the plain radiographs, computed tomography is mandatory to delineate fracture configuration. Anatomical reduction of the articular surface is the key for the management of these injuries. Residual articular step-off is associated with poor functional outcomes and high rate of post-traumatic degenerative changes of the tibiotalar joint.