Posterior Malleolus Fracture Splinting
For posterior malleolus fractures, a posterior splint is most useful to reduce pain, prevent further injury, and facilitate transport to a medical facility. 1
Splinting Approach for Posterior Malleolus Fractures
Initial Assessment
- Evaluate for signs of extremity fracture including deformity, swelling, bruising, severe pain with movement, inability to move the extremity, or visible protruding bone 1
- Check if the extremity is blue, purple, or pale, which may indicate poor perfusion requiring immediate activation of emergency response system 1
- Assess for open wounds associated with the fracture that may require additional management 1
Splinting Technique
- Apply a posterior splint to immobilize the ankle joint in a neutral position 1
- Maintain the fractured extremity in the position found unless straightening is necessary for safe transport 1
- Avoid excessive manipulation of the fracture site to prevent further injury 1
- Ensure the splint extends from below the knee to beyond the toes to properly immobilize the ankle joint 1
Special Considerations
- For posterior malleolus fractures with associated syndesmotic injury, proper immobilization is particularly important as these injuries affect ankle stability 2, 3
- Cover any open wounds associated with the fracture with a clean dressing to reduce risk of contamination and infection 1
- Monitor for signs of compartment syndrome or vascular compromise after splinting 1
Rationale for Posterior Splinting
Clinical Evidence
- Posterior splints provide better pain relief within the first 2 weeks of injury compared to other immobilization methods 1
- Splinting as a first aid measure helps reduce pain, prevent further injury, and facilitate transport to definitive care 1
- Proper immobilization is an essential part of fracture management, particularly for posterior malleolus fractures which affect ankle stability 2
Imaging Considerations
- CT imaging is often needed for proper evaluation of posterior malleolus fractures, as these can be complex and may be associated with syndesmotic injuries 1
- Posterior malleolus fractures are present in 7-44% of all ankle fractures and may require surgical fixation depending on fragment size, displacement, and associated injuries 2
- While awaiting definitive imaging and treatment, proper splinting is crucial to prevent displacement of fracture fragments 1
Common Pitfalls and Caveats
- Avoid overtightening the splint as this may compromise circulation and cause additional injury 1
- Do not attempt to reduce displaced fractures in the field unless necessary for safe transport 1
- Never delay transport to medical care, especially if there are signs of vascular compromise 1
- Don't underestimate posterior malleolus fractures - even small fragments can affect ankle stability and may require surgical fixation 4
- Avoid weight-bearing on the affected extremity until proper evaluation and treatment 1
Follow-up Care
- All posterior malleolus fractures require proper orthopedic evaluation 5
- Recent evidence suggests that surgical fixation of posterior malleolus fragments leads to better outcomes regardless of fragment size 4
- Definitive treatment will depend on fracture characteristics, associated injuries, and patient factors 6