Posterior Malleolus Fixation in Trimalleolar Ankle Fractures: Outcomes From a Single-Centre Retrospective Cohort

BACKGROUND: Fixation of the posterior malleolus in ankle fractures has evolved from simple size-based criteria to morphology-guided indications informed by computed tomography (CT). Direct posterior approaches now permit anatomic reduction of the posterior tibial plafond and restoration of syndesmotic stability. However, real-world functional outcomes and complication data from United Kingdom (UK) centres remain limited. OBJECTIVE: To describe patient-reported outcomes and complication patterns following morphology-guided posterior malleolus fixation for trimalleolar ankle fractures in a single National Health Service (NHS) teaching hospital. METHODS: We conducted a retrospective cohort study of patients with trimalleolar ankle fractures who underwent posterior malleolus fixation between 2020 and 2022. Functional outcome was assessed using the Olerud-Molander Ankle Score (OMAS). Scores were categorised as poor (