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

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.