Case for small group discussion Ankle fracture Case for small group discussion Ankle fracture with posterior malleolus impaction AOTrauma—Foot & Ankle Module 1a: Ankle trauma—ankle fractures Stefan Rammelt, DE

Case description 33-year-old woman Skiing injury Soft tissues closed No significant swelling Are additional investigations needed?

CT-scans Treatment options? Timing? Surgical approaches? Type of fixation?

Discuss surgical approaches

Stability through posterior syndesmosis fixation

Take-home messages Generous use of CT scans for posterior malleolar fractures Posterior approach when there is impaction Fixation with screws or buttress plate depends on fragment size and bone quality Stable fixation of posterior malleolus also results in syndesmotic stability Reconstruction of the posterior malleolus also reconstructs the tibial incisura References: Bartoníček J, Rammelt S, Tuček M, et al. Posterior malleolar fractures of the ankle. Eur J Trauma Emerg Surg. 2015 Dec;41(6):587-600. Rammelt S, Obruba P. An update on the evaluation and treatment of syndesmotic injuries. Eur J Trauma Emerg Surg. 2015 Dec;41(6):601-14. Bartonicek et al. Eur J Trauma Emerg Surg. 2015;41 587-600. Rammelt et al. Eur J Trauma Emerg Surg. 2015;41 601-614.