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Computer tomography scans for foot and ankle injuries were reviewed, and posterior malleolus fractures were included. Pathoanatomical data was collected and analysed according to known classification systems and subsequent treatment modalities evaluated. A panel of observers individually reviewed radiographic data to determine interobserver reliability.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 71 patients were included with a mean age of 41\u2009\u00b1\u200913.4\u00a0years (range 18\u201378) and a female predominant population (69%). A greater proportion of injuries were high energy (23.9%), with significant fragment comminution (53.5%), and half (52.1%) of all injuries were subluxated\/dislocated at presentation. A total of 93% of injuries were managed operatively, despite theatre access limitations resulting in significant delays to fixation (19.1\u00a0days). Despite good pathoanatomical agreement with most international classifications, interobserver reliability was poor (Krippendorff <jats:italic>\u03b1<\/jats:italic>-coefficient\u2009&lt;\u20090.667). Inconsistent treatment patterns in operative and non-operative strategies are reported.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>A unique patient population of younger, female individuals incurred posterior malleolar fractures due to higher energy mechanisms of injury. Whilst injury patterns were mostly comparable, significant interobserver variability was noted. Resource limitations, diagnostic challenges, poorly defined and inconsistent treatment strategies, inevitably impact outcomes within the South African population.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Level III.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00590-023-03702-y","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T16:04:56Z","timestamp":1693325096000},"page":"539-548","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The reliability of posterior malleolar ankle fracture assessment: a unique perspective"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2998-0829","authenticated-orcid":false,"given":"Edward Joseph","family":"F\u0171zy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0567-3373","authenticated-orcid":false,"given":"Nando","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0633-8227","authenticated-orcid":false,"given":"Craig","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2336-3085","authenticated-orcid":false,"given":"Daniel","family":"Hugo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6328-9110","authenticated-orcid":false,"given":"Etienne","family":"Joubert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2831-4960","authenticated-orcid":false,"given":"Marilize","family":"Burger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,8,29]]},"reference":[{"issue":"1","key":"3702_CR1","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1053\/j.jfas.2015.04.001","volume":"55","author":"S Odak","year":"2016","unstructured":"Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S (2016) Management of posterior malleolar fractures: a systematic review. 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Prior to the commencement of the study ethical approval was obtained from the following ethical review board:\u00a0Stellenbosch University Health Research Ethics Committee (C22\/08\/023)\u2014(HREC Reference #: N18\/09\/105).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal rights statement"}},{"value":"No informed consent for the collection of retrospective data was required. A waiver of consent for this data was granted by the Stellenbosch University Health Research Ethics Committee (C22\/08\/023).","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}