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Trimalleolar fractures refer to a three-part fracture of the ankle. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond (referred to as the posterior malleolus) and the lateral malleolus. Having three parts, this is a more unstable fracture and may be associated with ligamentous injury.
- measuring the size of the fracture fragment as a percentage of the total articular surface on the lateral radiograph or sagittal CT is useful as this is one of the indications for internal fixation (although operative threshold is variable) 2,3
- articular steps >1 mm are also an indication for internal fixation 2
- 1. Mainwaring BL, Daffner RH, Riemer BL. Pylon fractures of the ankle: a distinct clinical and radiologic entity. Radiology. 1988;168 (1): 215-8. doi:10.1148/radiology.168.1.3380962 - Pubmed citation
- 2. Conor Kleweno, Edward K. Rodriguez. Trimalleolar Ankle Fractures. (2018) Orthopedic Traumatology. doi:10.1007/978-3-319-73392-0_25 - Pubmed
- 3. Xing W, Xing WY, Xing SL, Xing WL, Xing KZ, Xing ZC, Xing ZZ, Xing. Ankle joint dislocation treating dislocated trimalleolar fractures accompanied with the complex posterior malleolus fracture without separation of the tibiofibular syndesmosis. (2018) Medicine. doi:10.1097/MD.0000000000012079 - Pubmed