Wang Z, Chen W, Zhu Y, et al. - This study attempted to ascertain the clinical incidence, missed diagnosis rate, and treatment strategies of this combined injury. Researchers carried out searches of PubMed, Cochrane, and MEDLINE Ovid databases for articles of English language from 1988 to 2020, distinguishing 1,549 papers. In this study, 21 of the 1,278 identified studies were eligible for inclusion. This study’s findings demonstrate that for individuals with tibial shaft fractures (TSFs), spiral TSFs, particularly distal third spiral TSFs, are closely related to posterior malleolar fractures (PMFs) and are often not sufficiently diagnosed by x-ray alone. It has been considered that advanced CT and MRI examinations can significantly decrease the missed diagnosis rate of occult PMFs. As per the findings, the treatment strategy for PMFs correlated with TSFs is questionable without convincing evidence of benefit.