Posterior Malleolar Fractures: From the "Forgotten Fragment" to Modern Concepts in Management

Posterior malleolar fractures (PMFs) affect ankle stability and patient prognosis. The posterior malleolus (PM) provides an articular surface, syndesmotic stability, and tibiotalar joint stability. Computed tomography (CT) scanning has changed the practice from size-based management to understanding the bigger picture, which includes considering fragment morphology, articular involvement, and syndesmotic stability. Treatment options range from conservative management in specific populations and fracture patterns to operative management for complex fractures that affect ankle joint integrity. Operative management options are controversial among orthopaedic surgeons. This focused review examines the anatomy, diagnosis, and various management strategies for PMFs.