Objective: To summarize updated evidence on the surgical fixation of Dupuytren fracture and current trends in the management of ankle syndesmotic injury, with emphasis on computed tomography, posterior malleolar fragments, dynamic suture-button fixation, and selective deltoid ligament repair. Materials and methods: This was a narrative review. Relevant literature was selected mainly from PubMed and open-access full-text sources, with priority given to systematic reviews, meta-analyses, randomized controlled trials, biomechanical studies, and clinically meaningful studies. The review focused on the main changes in injury concept, the role of modern imaging, and trends in fixation strategy. Results: Modern treatment concepts have shifted from isolated fibular fixation toward comprehensive restoration of ankle stability. Computed tomography has become fundamental in evaluating posterior malleolar morphology, articular step-off, and the quality of syndesmotic reduction. Indications for posterior malleolar fixation are increasingly based on fracture morphology, displacement, and mechanical contribution rather than fragment size alone. Dynamic suture-button fixation tends to provide improved functional outcomes and fewer implant-related complications than syndesmotic screws in several recent studies, although absolute clinical superiority remains context-dependent. Selective deltoid ligament repair may reduce residual malreduction in patients with persistent medial instability.
Conclusions: Dupuytren fracture should be regarded as a complex unstable ankle injury. Optimal current management requires anatomic fibular reduction, active CT-based assessment of the posterior malleolus, individualized choice between syndesmotic screws and dynamic suture-button fixation, and careful consideration of medial-sided injury on a case-by-case basis.