Fracture of the lower leg with involvement of the posterior malleolus; a neglected combination?

In 17 of 148 fractures of the leg (11.5 per cent) we found an isolated fracture of the posterior malleolus of the tibia as a sign of associated injury of the ankle joint. In two cases there was even disruption of the anterior syndesmosis. All fractures of the tibia were oblique and closed without severe soft tissue injury and caused by a rotational force with low energy. In fracture of the leg of this specific type a radiological examination of the ankle joint in search for a posterior malleolar fracture is needed. If present, instability of the distal tibio-fibular joint must be excluded.