Trimalleolar fracture

See also: Bimalleolar fracture

A trimalleolar fracture is a fracture of the ankle that involves the lateral malleolus, the medial malleolus, and the distal posterior aspect of the tibia, which can be termed the posterior malleolus. The trauma is sometimes accompanied by ligament damage and dislocation.

Trimalleolar fracture
X-ray of trimalleolar fracture repair before and after ORIF surgery
Specialty	Orthopedics

The three aforementioned parts of bone articulate with the talus bone of the foot. Strictly speaking, there are only two malleoli (medial and lateral), but the term trimalleolar is used nevertheless and as such is a misnomer. The trimalleolar fracture is also known as cotton fracture.

Treatment

X-ray of trimalleolar fracture repair with plate and nails

Surgical repair using open reduction and internal fixation is generally required, and because there is no lateral restraint of the foot, the ankle cannot bear any weight while the bone knits. This typically takes six weeks in an otherwise healthy person, but can take as much as twelve weeks. Non-surgical treatment may sometimes be considered in cases where the patient has significant health problems or where the risk of surgery may be too great.

Further reading

• Weber, Martin (2004). "Trimalleolar Fractures with Impaction of the Posteromedial Tibial Plafond: Implications for Talar Stability". Foot & Ankle International. 25 (10): 716–27. doi:10.1177/107110070402501005. PMID 15566703. S2CID 43182738.
• Weber, Martin; Ganz, Reinhold (2003). "Malunion following Trimalleolar Fracture with Posterolateral Subluxation of the Talus — Reconstruction Including the Posterior Malleolus". Foot & Ankle International. 24 (4): 338–44. doi:10.1177/107110070302400406. PMID 12735377. S2CID 20888046.
• Bucholz, R. W.; Henry, S; Henley, M. B. (1994). "Fixation with bioabsorbable screws for the treatment of fractures of the ankle". The Journal of Bone and Joint Surgery. 76 (3): 319–24. doi:10.2106/00004623-199403000-00001. PMID 8126036.
• Haraguchi, Naoki; Haruyama, H; Toga, H; Kato, F (2006). "Pathoanatomy of Posterior Malleolar Fractures of the Ankle". The Journal of Bone and Joint Surgery. 88 (5): 1085–92. doi:10.2106/JBJS.E.00856. PMID 16651584.
• Langenhuijsen, Johan F.; Heetveld, Martin J.; Ultee, Jan M.; Steller, E. Philip; Butzelaar, Rudi M. J. M. (2002). "Results of Ankle Fractures with Involvement of the Posterior Tibial Margin". The Journal of Trauma: Injury, Infection, and Critical Care. 53 (1): 55–60. doi:10.1097/00005373-200207000-00012. PMID 12131390.
• Van Den Bekerom, Michel P. J.; Haverkamp, Daniel; Kloen, Peter (2009). "Biomechanical and Clinical Evaluation of Posterior Malleolar Fractures. A Systematic Review of the Literature". The Journal of Trauma: Injury, Infection, and Critical Care. 66 (1): 279–84. doi:10.1097/TA.0b013e318187eb16. PMID 19131839.
• Helmy, Naeder; Meyer, Dominik C.; Vienne, Patrick; Espinosa, Norman (2012). "The Posterolateral Approach for the Treatment of Trimalleolar Fractures". Techniques in Foot & Ankle Surgery. 11 (4): 189–93. doi:10.1097/BTF.0b013e3182743f11.
• Forberger, Jens; Sabandal, Philipp V.; Dietrich, Michael; Gralla, Jan; Lattmann, Thomas; Platz, Andreas (2009). "Posterolateral Approach to the Displaced Posterior Malleolus: Functional Outcome and Local Morbidity". Foot & Ankle International. 30 (4): 309–14. doi:10.3113/FAI.2009.0309. PMID 19356354. S2CID 34963028.