Conservative Treatment of Posterior Malleolus of the Ankle Fracture versus Internal Fixation

Ankle fractures are relatively common and often have involvement of the posterior malleolus. Treatment guidelines exist is limited with several controversies exist in the management of posterior malleolus fractures. The purpose of this review was to evaluate the evidence about indications, effectiveness and complications of conservative treatment and internal fixation of posterior malleolus fracture. To review the literature in last ten years about the indications, effectiveness and complications of conservative treatment of posterior malleolus of ankle fracture versus surgical internal fixation. We conducted an electronic search between 2010 to 2020 in different databases, PubMed, Scopus, Web of Science, and Cochrane Library. We included randomized controlled trials (RCTs), prospective or retrospective cohort, case control studies, and case series that were published in English with full text available. There was no restriction to age or gender of the patients during literature search. If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. The decision on whether or not to apply open reduction and internal fixation for a posterior malleolar fragment is based on insufficient evidence as most of previous studies are small in sample size with retrospective design, also there is limited data on conservative treatment. Till now the choice of line of treatment, in generally, most authors of clinical studies agree that operative treatment is indicated for large fragment and in cases with small fragment size, is left to the surgeon preference and patients' presentation.