Isolated Posterior Malleolus Fractures: A Systematic Review

Objective(s): To conduct a systematic review to elucidate the mechanism, evaluation, operative indications, and outcomes of isolated posterior malleolus fractures.

Data Sources: PubMed, Cochrane, and EMBASE databases from database inception to March 31, 2023

Study Selection: Inclusion criteria was adult patients (≥18 years old), full text articles, and isolated posterior malleolar fractures with 26 articles meeting inclusion criteria.

Data Extraction: Data was extracted by multiple authors. Data extracted included study type, number of patients, follow-up time, mechanism of injury, location of pain, type of imaging, and if treatment was surgical or non-surgical.

Data Synthesis: Total number of patients included in this studies cohort was 117. Patients had an average follow-up time of 70.9 ± 86.0 months. Of the 76 patients with mechanism of injury noted, 67% resulted from a plantarflexed foot position followed by an axial compressive force and 29% resulted from a nonspecific rotational injury. Eighteen patients (44%) had tenderness of the posterolateral or posteromedial ankle when specific palpation was documented (n=41). In 88 cases of isolated posterior malleolus fractures with documented radiographs at the first medical evaluation, 24% did not demonstrate a fracture. Of the cohort (n = 117), 28 patients (23.9%) underwent operative treatment, and 89 patients (76.1%) underwent non-operative.

Conclusions: The current literature on isolated posterior malleolus fractures is primarily confined to case reports and small case series. Identifying the presence and morphology of these injuries can be difficult. Nonsurgical management has been the mainstay of treatment. Further study is needed to supplement our current understanding of isolated posterior malleolus fractures, particularly clarity of operative indications.

Author(s) Disclosures: The authors have no relevant disclosures to make known at this time.