Posterior malleolus fractures are usually seen in the substantial portion of patients admitted to the hospital after rotational ankle injuries. The majority of these injuries accompanies trimalleolar fractures. Posterior malleolus is an important structure for the rotational stability of the ankle joint as well as for the syndesmosis complex stability. Therefore it is important to treat trimalleolar fractures properly, otherwise the prognosis will be worse. Despite the increased interest and awareness in diagnosis and treatment of posterior malleolus fracture, there are still many controversial issues. The posterior malleolus fractures are difficult to diagnose because of the wide variety of the morphology. The debate for preferences in diagnosis, classification and treatment is ongoing. One of the topics which provided consensus is the importance of using computerized tomography (CT) and 3D-CT in planning diagnosis and treatment. In current approaches, the stability of the distal tibiofibular mortise and the appropriate reduction of the distal fibula in fibular notch has begun to be important parameters for the treatment choice. In the treatment of ankle fractures, it should be noted that the stability of the ankle joint is provided by both soft tissue and bone complex, and careful consideration should be given to all details while planning treatment.