Modified Posterolateral Approach for Fixation of Posterior Malleolus Fractures Associated with Distal Tibiofibular Syndesmosis Injury – Description of Surgical Technique.

Posterior malleolus fractures are a challenge in the treatment of ankle injuries and, if not treated properly, can lead to unfavorable results, especially when associated with syndesmosis injury. Posterior approaches (posterolateral and posteromedial) are recommended for adequate reduction and fixation of the posterior malleolus, but they usually do not allow direct visualization of the syndesmosis, one of the main prognostic factors in the treatment of these injuries. We present a modification of the posterolateral approach that allows direct visualization of the syndesmosis and the use of syndesmosis fixation implants coupled to lateral implants when associated with lateral malleolus fracture.