Ankle fractures are one of the most common lower extremity injuries, particularly tri-malleolar fractures, provide substantial hurdles to orthopedic surgeons due to their complicated nature (Pflüger et al., 2021), occurring in around 179 out of 100,000 persons each year (Juto, Nilsson, & Morberg, 2018). However, posterior malleolus involvement may not be as uncommon as previously believed. According to the literature, the incidence of posterior malleolar fractures can reach 44%, necessitating additional strategic planning for the repair of displaced articular fracture patterns (Irwin, Lien, & Kadakia, 2013Shi, Xiong, Chen, Wang, Qiu, Huang, Gui, Wen, & Wang, 2017).

Objectives: The unique fracture features, surgeon expertise, and patient considerations should all be taken into account while deciding between the two positions.

Methodology: This study is based on data collected from a tertiary care hospital that treated a cohort of patients with tri-malleolar ankle fractures. Patients were separated into two groups: those who had their reductions in the prone position and those who had them in the supine position. Radiographic studies, clinical examinations, and surgical problems were all used to determine the appropriateness of reduction.

Results and Discussion:

The comparison investigation demonstrated that both the prone and supine positions can effectively reduce third malleolar fractures in tri-malleolar ankle fractures. These results are in line with the results of Tosun, Selek, Gok, and  Ceylan, (2018) which were reported as posterior malleolar fracture repair is strongly associated with favorable radiological and functional outcomes following trimalleolar fractures. The unique fracture features, surgeon expertise, and patient considerations should all be taken into account while deciding between the two positions. While the supine position may offer advantages in terms of anterior visibility and potential reduction in neurovascular problems, the prone position remains a viable and time-tested technique for resolving posterior malleolar fractures.

Conclusion:

The choice between prone and supine postures in the reduction of third malleolar fractures in tri-malleolar ankle fractures is a difficult one that should be tailored to each patient. Our tertiary care center's experiences indicate that both positions can produce satisfactory results when used correctly. More research and larger studies are needed to develop more solid guidelines, taking into account the different aspects impacting the choice of location and subsequent reduction strategies in these complex ankle fractures.

Key Words: Ankle fractures, complicated, extremity injuries, posterior malleolar