Starting with Lorenz Heister, ankle fractures are dealt within German textbooks since the early 18th century. The Austrian surgeon Hönigschmied, in 1877, published a landmark series of biomechanical studies on the mechanism of fractures and avulsions around the ankle that are still valid today.
German-speaking authors contributed particularly to the recognition and treatment of posterior malleolar fractures and fractures of the anterolateral distal tibia. The term "Volkmann Triangle", however, is historically incorrect, as Volkmann most likely was the first to treat an anterolateral distal tibial fracture by resection but never described a posterior malleolar fracture.
The founding of the AO (Arbeitsgemeinschaft für Osteosynthesefragen) by Swiss surgeons and engineers profoundly influenced evaluation and treatment of fractures worldwide. Proponents like Weber and Heim coined the modern principles of the treatment of malleolar and pilon fractures that are still in use and continue to evolve.