Fractures of the posterior malleolus as a part of complex ankle fractures: Trends in diagnosis and treatment at our institution.

Introduction: The management of posterior malleolus fractures has experienced notable advancements in recent years, predominantly driven by the CT-based Bartoníček-Rammelt classification. This study aims to systematically document the evolving trends in the approach to these fractures within the context of our institution.

Methods: A comprehensive retrospective analysis was undertaken involving 66 patients who underwent surgical intervention for posterior malleolus fractures at our institution during the years 2020 and 2021. Patient classification was conducted based on the Lauge-Hansen classification, with additional categorization according to the Bartoníček-Rammelt classification in instances where CT scans were performed.

Results: CT examinations were performed in 30 patients (45.45%); according to the Bartoníček-Rammelt classification they revealed type I in 2 cases, type II in 7 cases, type III in 12 cases, and type IV in 9 cases. Patients lacking specific fixation for type III posterior malleolus fractures, as per the Bartoníček-Rammelt classification, exhibited the most unfavorable treatment outcomes.

Conclusion: Our findings elucidate a progressive trend in the utilization of CT examinations between 2020 and 2021, although this escalation remained insufficient during this period. Consequently, we have intensified efforts to advocate for increased use of CT scans. The issues with not optimally treated type III fractures, as classified by Bartoníček-Rammelt, are quite clear from our study. We were surprised by how often these cases occurred, and they often led to more complications. These fractures diagnosed by CT scans were not treated optimally, as surgeons tend to be reluctant in adopting modern treatment procedures. This emphasizes the importance of ongoing and thorough education in all kinds of healthcare settings, including those that specialize in ankle and foot surgery.