To explore the operative indications for posterior malleolar fractures.

A retrospective study was conducted to analyze the clinical data of the whole year of 2011 of 298 combined fractures of ankle joint and posterior malleolus. They were 143 males and 155 females, 14 to 85 years of age (average, 43 years). Laterality: 152 right sides and 146 left sides. Associations of surgical fixation were analyzed respectively with dislocation of the tibiotalar joint, Danis-Weber classification of the ankle fracture, Haraguchi classification of posterior malleolar fracture, and fragmental size of posterior malleolar fracture.

Significantly more posterior malleolar fractures combined with dislocation of the tibiotalar joint (57. 0% ) were subjected to surgical fixation than those without (34. 0% ) (P < 0. 05). Significantly more Haraguchi type Ⅱ fractures (73. 8% ) were subjected to surgical fixation than those of Haraguchi type I (35. 5% ) and type Ⅲ (P < 0. 05). The fixation ratio increased significantly when the posterior fragment was more than 15% of the total joint area (P < 0. 05). There was no significant association between the Danis-Weber classification and surgical fixation (P > 0. 05).

In clinical treatment of posterior malleolar fractures, the factors influencing operative decision include combined dislocation of the tibiotalar joint, Haraguchi type Ⅱ, and fragmental size more than 15% of the total joint area.

Ankle joint; Fractures, bone; Fracture fixation, internal; Indication