Medial Malleolus Fracture

Fractures can be difficult to handle. Most fractures usually happen suddenly and unexpectedly, and nobody wants it to occur to them. However, cases like this can happen from time to time and what fractured patients can do is to be optimistic at the same time realistic of outcomes. On this article a particular kind of fracture will be discussed, and it is called a Medial Malleolus Fracture.

What is a Medial Malleolus Fracture?

A Medial Malleolus Fracture is a crack or break in the medial malleolus (plural form: malleoli). This type of fracture is typically seen with patients who have had rotational forces acted on the leg or after landing from a forceful and impactful jump.

This is sometimes accompanied by fractures and dislocations of the structures near the medial malleolus such as lateral malleolus fracture and talus fracture. To visualize the location of the fractures better, it is best to discuss the basic anatomy of the skeletal system of the lower leg. ^{[1,2, 3, 4]}

The lower leg is composed of two main long bones- the tibia and the fibula. The tibia is the larger bone located in the medial or the inner part of the leg. This is also commonly called as the shin bone in layman’s term. On the other hand, the smaller long bone of the lower leg is called the fibula which is located, this time, in the lateral or outer portion of the leg.

The fibula is not as easily palpated as the tibia. The medial malleolus, more importantly, is located in the distal or lower region of the tibia which also forms the inner bulge of the ankle. If a person swipes his palm on the inner ankle area, chances are, he or she can easily palpate a bony prominence- this bony prominence is part of the medial malleolus. ^{[1, 2, 3, 4]}

Figure 1 Basic Anatomy of the Lower Leg

Causes

The ankle and its surrounding structures are usually adequately protected; however, old age, unhealthy diet, low calcium level, and lack of exercise can compromise bone’s protection- n from outside forces. And even if the bone is considered healthy, too much force and impact on the ankle area can cause its fracture. Medial Malleolus Fracture usually happens after a forceful jump especially on uneven surfaces and/or strong rotational forces. ^{[2, 3, 4]}

People who are engaged in activities that involve running and jumping activities with frequent changing of directions are susceptible to this type of fracture. Samples of these activities include certain contact sports such as basketball, football, and rugby.

People in extreme games and activities such as motocross, skateboarding, and parkour, as well as other athletic events such as martial arts and gymnastics can also get this particular type of fracture. Some cases involve fall, vehicular, and other types of accidents. ^{[1, 3]}

Signs and Symptoms

Common signs and symptoms associated with Medial Malleolus Fracture include:

• Deformity around the ankle
• Inflammation or swelling
• Hematoma
• Bony Tenderness
• Instability and pain on attempting to walk
• Pain on the inner side of the ankle

Diagnosis

• Medical History and Physical Examination
• Diagnostic Examinations which include: X-ray, Stress Test, Computed Tomography (CT) Scan, Magnetic Resonance Imaging (MRI) Scan

Figure 2 – X-ray of Medial Malleolus Fracture^{[3, 5, 6]}

Treatment

Once Medial Malleolus is detected by the physician, medical intervention is determined. Medial Malleolus Fractures that are less severe and not “out-of-position” can be treated through immobilization and non-surgical methods.

Basically, only a small fragment of bone is affected and cannot be effectively repaired by surgery. A stress test x-ray may be done to determine the stability of the ankle. The site of the fracture must be protected with a short leg cast or a removable brace. Using of weights is usually done after six weeks. Regular check-ups are with repeat x-rays are done to ensure correct positioning of the bones.

If the ankle is unstable or if the bones are displaced, surgical interventions may be needed. The fracture may be fixed using screws, plates, or different wiring techniques. Impacted or indented ankle joints may require bone grafting.

There are also cases of Medial Malleolus Fracture in which the bone is not out of place but still needs surgery to promote earlier healing and mobility. The bone heals in about six to eight weeks.

Proper care during the recovery phase promotes better progress with regards to the bone healing process. These are some of the managements done during the recovery phase:

Pain management

Through relaxation techniques and analgesia if required

Rehabilitation

Strengthening exercises are done eventually as advised by the physician to return to previous mobility as possible

Weight bearing

Timing must always be advised by the physician to prevent failure of treatment

Supports

Casts or ankle brace must be properly placed and used as prescribed by the physician^{[4, 6]}

Pictures

Classification of Medial Malleolus Fracture

Classification of Medial Malleolus Fracture

References:
1.) PHILIPPINE edition entitled ESSENTIALS OF HUMAN ANATOMY & PHYSIOLOGY, 8^th Edition by MARIEB, ELAINE N., published by PEARSON EDUCATION SOUTH ASIA PTE LTD. Copyright @ 2006
2.) https://www.verywell.com/kinds-of-medial-malleolus-fractures-broken-ankle-1337794
3.) https://www.physioadvisor.com.au/injuries/ankle/medial-malleolus-fracture/
4.) Ekman, Anna and Brauer, Lena: Malleolar Fractures pdf
5.) http://orthoinfo.aaos.org/topic.cfm?topic=a00391