Advancements in the diagnosis and management of complex trimalleolar ankle fractures: A comprehensive review

Table 1 Key points

Section	Key points
Epidemiology and costs	High incidence in older adults, significant economic burden
Aetiology	Commonly caused by twisting, falls, or impact injuries
Classification	Multiple systems used (Pott, Lauge-Hansen, Weber, AO, CT-based)
Clinical evaluation	Pain, swelling, neurovascular risk; Tscherne classification guides soft tissue care
Diagnosis	Radiographs first-line; CT critical for surgical planning
Damage control	External fixation stabilizes open/high-risk fractures; Illizarov allows early weight-bearing
Timing of ORIF	ORIF within 6 days improves outcomes; delayed surgery raises infection risk
Lateral malleolus	Intramedullary nailing preferred for high-risk patients; locking plates also effective
Medial malleolus	ORIF standard; conservative treatment possible if anatomically reduced
Posterior malleolus	Fragment size and type guide fixation; direct posterior approach preferred for large PMF
Syndesmosis	Dynamic fixation (suture buttons) preferred over screws in some cases
Arthroscopy	Useful in active patients for intra-articular injury management
Deltoid ligament	Repair improves medial stability; especially in multi-ligamentous injuries
Postoperative care	OMAS, AOFAS scores used; early weight-bearing improves recovery but risks complications
Complications	Includes DVT, sepsis, MI, AKI; occur mostly within 30 days post-op

AO: Arbeitsgemeinschaft fur osteosynthesefragen; CT: Computed tomography; ORIF: Open reduction internal fixation; PMF: Posterio malleolar fracture; OMAS: Olerud-Molander Ankle Score; AOFAS: American Orthopaedic Foot and Ankle Score; DVT: Deep vein thrombosis; MI: Myocardial infarction; AKI: Acute kidney injury.