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The authors describe a case involving an isolated posterior fibular malleolar fracture in an 80-year-old female, which was identified on multiple lateral radiographs of the involved ankle and confirmed by computed tomography. The patient was treated conservatively with 10 weeks of walking cast immobilization, resulting in poorly acceptable radiographic and clinical results. The authors review the anatomy of the area of involvement. A literature review, the clinical case study, and a discussion of the difficulty in evaluation of these types of fibular fractures are presented along with a protocol for the diagnosis and treatment of these fractures.