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The best treatment is still subject to debate. The aim of this study was to assess the medium-to-long-term clinical and functional outcome of ankle fractures with a PM fragment in a larger patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>One hundred patients (69 women, 31 men, average age 60 years) with ankle fractures including the PM were evaluated clinically and radiographically. Patients with Barton\u00ed\u010dek\u2013Rammelt type 3 and 4 fracture displayed a significant female preponderance. Fixation of the PM was performed in 63% and tailored to the individual fracture pattern.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Internal fixation of the PM fragment was negatively correlated with the need for syndesmotic screw placement at the time of surgery (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). At an average follow-up of 7.0\u00a0years, the mean Foot Function Index (FFI) was 16.5 (\n                      <jats:italic>SD: 21.5<\/jats:italic>\n                      ), the Olerud Molander Ankle Score (OMAS) averaged 80.2 (\n                      <jats:italic>SD: 24<\/jats:italic>\n                      ) and the American Orthopedic Foot &amp; Ankle Society (AOFAS) ankle\/hindfoot score averaged 87.5 (\n                      <jats:italic>SD: 19.1<\/jats:italic>\n                      ). The maximum score of 100 was achieved by 44% of patients. The physical (PCS) and mental health component summary (MCS) scores of the SF-36 averaged 47.7 (\n                      <jats:italic>SD: 12.51<\/jats:italic>\n                      ) and 50.5 (\n                      <jats:italic>SD: 9.36<\/jats:italic>\n                      ), respectively. Range of motion was within 3.4 (\n                      <jats:italic>SD: 6.63<\/jats:italic>\n                      ) degrees of the uninjured side. The size of the PM fragment had no prognostic value. There was a trend to lower outcome scores with slight anterior or posterior shift of the distal fibula within the tibial incisura. Patients who underwent primary internal fixation had significantly superior SF-36 MCS than patients who underwent staged internal fixation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.031).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>With an individualized treatment protocol, tailored to the CT-based assessment of PM fractures, favorable medium and long-term results can be expected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-021-03875-3","type":"journal-article","created":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T07:08:22Z","timestamp":1617952102000},"page":"1823-1834","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Ankle fractures involving the posterior malleolus: patient characteristics and 7-year results in 100 cases"],"prefix":"10.1007","volume":"142","author":[{"given":"Annika Pauline","family":"Neumann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1141-6493","authenticated-orcid":false,"given":"Stefan","family":"Rammelt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,9]]},"reference":[{"key":"3875_CR1","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1097\/00005373-198911000-00018","volume":"29","author":"R Jaskulka","year":"1989","unstructured":"Jaskulka R, Ittner G, Schedl R (1989) Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. 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