Isolated Posterior Malleolar Fracture: A Case Report of a Rare Presentation With Narrative Review of Literature

Abstract

The isolated posterior malleolar fracture is a rare case. An innocuous injury may have associated ligamentous disruption. The fracture classification and treatment protocol are not well-defined. A missed injury results in poor functional outcomes.A 28-year-old male sustained a twisting injury to his left ankle. The radiograph revealed an isolated posterior malleolar fracture. A computerized tomographic examination suggested talus lateralization and deltoid ligament injury. Surgical fixation with a syndesmotic screw was done. Post-operative delayed weight-bearing was allowed. At a one-year follow-up, there was painless weight-bearing and independent mobilization.The posterior malleolus significantly contributes to ankle stability. The estimation of fragment size may be an erroneous guiding factor for surgical fixation. Recent literature suggests that syndesmotic stability, residual talus subluxation, joint congruence, and fibular notch involvement are more significant factors for risk assessment and to guide the management of posterior malleolar fracture.The isolated posterior malleolar fracture presents rarely. They should be evaluated by tomographic evaluation and an unstable injury should be surgically managed.

Isolated Fracture of the Posterior Tibial Margin: A Case Report

“…Rare cases of isolated fractures of the posterior margin of the tibia have been reported, they are often associated with ligament damage. These are benign fractures mimicking an ankle sprain but cause serious complications and poor functional results [ 2 , 3 ].…”

“…Tomar et al also reported the case of a young patient who, following a sprain while walking on uneven ground, who presented with an isolated fracture of the posterior marginal of the tibia associated with a probable rupture of the deltoid ligament. This fracture was treated surgically and the functional results were satisfactory [ 2 ]. Other cases of isolated fractures of the posterior marginal of the tibia with associated ligamentous damage have been reported in the literature by Smeeing et al and Serbest et al [ 3 , 4 ].…”

“…Isolated fractures of the posterior marginal tibia are rare and initially described as “paratrooper fractures”, they represent only 0.5 to 1% of ankle fractures and there is a clear male predominance [ 2 , 3 ]. These fractures occur in an anatomical area where the tissue coverage is thin and particularly exposed, therefore with a high rate of complications [ 3 ].…”