• OBJECTIVE
    • To describe the radiographic consequences of posterior malleolus fractures (PMF) present with tibial shaft fractures fixed with intramedullary nails.
  • DESIGN
    • Retrospective cohort study.
  • SETTING
    • Level 1 trauma center.
  • PATIENTS/PARTICIPANTS
    • Seven hundred thirty-three patients with tibial shaft fractures.
  • INTERVENTION
    • Intramedullary nail fixation and prophylactic articular fixation.
  • MAIN OUTCOME MEASURE
    • Displacement of PMF with intramedullary nail insertion.
  • RESULTS
    • Seven hundred thirty-three patients were identified with tibial shaft fractures treated with intramedullary nail fixation at a Level 1 trauma center without a uniform preoperative computed tomography protocol. One hundred thirty-three patients had an identifiable PMF appreciated on preoperative imaging. Of the 600 remaining patients without a known PMF, 29 had PMF identified after nail insertion: 24 patients with nondisplaced fractures that all healed radiographically at final follow-up, 3 patients had fractures <30% of the articular surface displaced 1-2 mm, and 2 patients had fractures >30% of the joint surface that displaced 1-2 mm.
  • CONCLUSIONS
    • The incidence of radiographically observable PMF associated with tibial shaft fractures is high, even without a preoperative computed tomography screening protocol in place. In patients without an appreciable PMF on injury films, less than 1% (2/600) had displacement of a large, clinically significant PMF with nail placement.
  • LEVEL OF EVIDENCE
    • Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.