Authors:

Abstract

Aims:

1. To identify evidence in the literature for management strategies for posterior malleolar ankle fractures
2. To identify current management strategies for posterior malleolar ankle fractures
3. To identify factors which affect patient decisions on management for posterior malleolar ankle fractures
4. To identify factors which affect surgeon decision of management for posterior malleolar ankle fractures

Study design:

• Literature review of previous evidence
• Local audit assessing current practice in line with BOAST guidelines
• Patient questionnaire asking what factors impact on their decision to undergo surgical treatment
• Consultant questionnaire focusing on management decision and factors affecting their decision to operate

Patients: In the UK, of the fractures sustained by patients between the ages of 20 and 65 years those involving the ankle are the most common, with an incidence of almost 90 000 per year (Dattani 2008). The anatomical classification system of Danis and Weber (Danis 1949; Weber 1972) subgroups fibular fractures as A (below the syndesmosis), B (at the syndesmosis) or C (above the syndesmosis) depending on the relationship of the fracture to the syndesmosis (Donken 2012). As well as the site of the fracture in relation to the syndesmosis, these injuries can be complicated by the involvement of the medial and posterior malleolars. Indications for surgery are varied with little evidence in the literature such as more than 25% of the articular surface being involved (Wheeless 2016). For non surgical management, a modified casting technique has been developed, close contact casting, which uses minimal padding compared with traditional casting and achieves fracture reduction by distributing contact pressure by close anatomic fit. This has been advocated in the management of posterior malleolar fracture fractures in certain circumstances (Donken 2011).

Outcome(s): To add to limited previous evidence about the management of posterior malleolar fractures.