Trimalleolar fracture with involvement of the entire posterior plafond

A special type of trimalleolar fracture with the involvement of the entire posterior tibial plafond has been reported recently. Because of the low incidence, the characteristics of the fracture in different studies have not been consistent. We describe our clinical experience with this fracture type.

From January 2007 to December 2009, 12 patients were identified with a trimalleolar fracture with involvement of entire posterior tibial plafond. All the fractures were openly reduced and fixed through a combined operative approach (posterolateral and posteromedial). Ten of 12 patients were followed up. The clinical outcome was assessed with the Short Form-36 (SF-36) and standardized AAOS foot and ankle questionnaire, and the radiological evaluation with an osteoarthritis-score (OA-score).

Based on the pathoanatomy of the posteromedial malleolar fragment, all the fractures could be classified into two types. Using a combined operative approach, anatomical reduction and stable fixation was accomplished in all 12 patients. At a mean followup of 18.9 (range, 12 to 30) months, 10 patients achieved a good radiological result and satisfactory clinical recovery.

This fracture pattern may be classified into two types with different injury mechanisms, which has not been described previously. After anatomic reduction and stable fixation through a combined operative approach, the short-term outcome was good.