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

Table 2 Summary of treatment options for trimalleolar ankle fractures by fracture component

Fracture component	Main surgical options	Indications/notes	Advantages	Limitations/concerns
Lateral malleolus	Intramedullary fibular nailing; locking/antiglide plates	Weber B and C fractures; osteoporotic bone; high-risk soft tissue	Minimally invasive, preserves soft tissue, short operative time	Risk of hardware irritation; nail compliance issues
Medial malleolus	ORIF with single or dual screws; tension-band wiring; antiglide plating	Anatomically aligned vs displaced fractures; vertical/comminuted patterns (Herscovici types B-D)	Stable fixation, simple technique	Wire migration, need for hardware removal; risk of non-union
Posterior malleolus	Posterior plating (buttress/antiglide); anteroposterior screws	> 25% articular surface, talus dislocation, Haraguchi type II/III	Direct visualization, anatomical reduction, early weight-bearing	Increased operative time, wound complications
Tibiofibular syndesmosis	Cortical button fixation; high-strength suture constructs; traditional screws	Syndesmotic disruption or instability	Preserves physiological motion, less need for removal, fewer reoperations	Cost, learning curve; screw breakage if conventional fixation used

ORIF: Open reduction and internal fixation.