Surgical approaches for the treatment of posterior malleolar fracture: which one to choose?

Evidence suggests that posterior approaches may be superior to the anterior percutaneous approach in terms of reduction quality and functional outcomes. There is no consensus regarding the definition of the posteromedial approach and its modifications, which can cause confusion when evaluating outcomes. Several variables must be considered when choosing a surgical approach, with particular importance given to the morphology of the posterior malleolus fracture, the presence of a complex fibula fracture, and the presence of Tillaux-Chaput or Le Fort-Wagstaffe fractures. This article provides an overview of approaches to posterior malleolus fractures and presents recommendations for approach selection in specific clinical scenarios.