Posterior Malleolus Fractures in Athletes

Ankle injuries are the most common sports-related injuries in athletes, the majority of which are sprains or partial ligament tears. They most often occur in basketball and soccer, but essentially no sports are immune to ankle injuries. Ankle fractures occur less commonly than sprains, and are typically due to higher energy mechanisms. When dealing specifically with fractures of the posterior malleolus, these occur most often from a rotational injury, and are typically associated with fractures of one or both the other malleoli. The anatomy of the posterior ligaments, their osseous attachments, the weight bearing surface, and buttress effect of the posterior malleolus, make this a critical area of the ankle. There has been considerable debate as to the appropriate treatment of posterior malleolar fractures in the literature. In general, treatment has evolved from simple closed reduction and casting, to open reduction and internal fixation in most cases for reliable healing, restoration of anatomy, and expeditious return to play.