Integrating Quadrimalleolar Fractures of the Ankle in a Johannesburg Academic Center: A New Classification

Background Quadrimalleolar ankle fractures, which consist of trimalleolar fractures with additional anterior fractures, were initially described in a case report. We present a limited series of unusual fractures of the four ankle malleoli and demographic variables to create a comprehensive quadrimalleolar ankle fracture classification system. Methodology We conducted a retrospective review of CT scans of patients who sustained ankle fractures at our academic hospital over three years. We included patients who had sustained quadrimalleolar ankle fractures. We classified all fractures based on preoperative CT scans. Results A total of 145 CT scans were reviewed, demonstrating quadrimalleolar ankle fractures in just eight cases. Of the eight cases included, 75% were male, and the mean age at the time of injury was 39 years (range = 21-59 years). We integrated quadrimalleaolar ankle fractures into four classifications based on the fracture pattern. Conclusions Recognizing these unique fracture patterns as distinct entities would contribute to more comprehensive knowledge and improve the classification system for quadrimalloelar ankle fractures and patient care.