Perspective Chapter: Trimalleolar Fracture

A trimalleolar fracture is an ankle fracture involving the posterior malleolus, which ranges from small avulsions to large intra-articular fragments, with impacted small fragments causing subluxation of the talus. Proper evaluation, including detailed radiographic imaging, is essential for accurate classification and treatment planning. A trimalleolar ankle fracture is inherently unstable, with possible syndesmotic disruption. Computed tomography is the gold standard for diagnosis, staging, and surgical planning. However, the management of trimalleolar ankle fractures is controversial in terms of approaches, fixation methods, postoperative rehabilitation, and weight-bearing protocols. The author generated a grading system based on CT, demonstrating four grades that facilitate management, are relevant for prognosis, and can be applied in research and clinical settings. This chapter aims to provide a comprehensive review of trimalleolar ankle fractures, highlighting the mechanisms of injury, diagnostic approaches, grading system, surgical treatment options, and complications.