Medial Malleolus Fracture: Causes, Symptoms, Treatment, Recovery Time, Diagnosis
What is Medial Malleolus Fracture?
Medial malleolus fracture is a break in the bony structure at the inner side of the ankle. It is simply, also called as broken ankle, the break being on the inner side. Medial malleolus is a part of the lower leg bone and can be easily felt with hands on the inner side of the ankle. The lower leg has two bones, tibia on the inner side and fibula on the outer side. Both the bones end with a bump on inner and outer side, which form a part of the ankle. Medial malleolus is a bump in the lowermost part of tibia and it can break due to various causes.
The way in which the bone breaks defines the types of medial malleolus fracture. Some of the commonest types of medial malleolus fracture include the following:
Avulsion Fracture – It is associated with injury or tear of the ankle joint ligament, which pulls a small part of the bone, where the ligament is attached.
Transverse Fracture – It is a horizontal break in the bony prominence or medial malleolus.
Oblique Fracture – In this, the break is oblique at the corner of the medial malleolus and is usually due to rotational injury and may also be associated with injury to the fibula.
Vertical Fracture – Vertical medial malleolus fracture occurs due to a vertical break in the bone and can also affect the main part of the ankle joint.
Comminuted Fracture – In this, the fracture of medial malleolus results in multiple breaks in the bones.
Medial malleolus fracture is often a part of other injuries or fractures of other bones, while sometimes it can also be an isolated fracture. Ankle fractures are one of the commonest fractures of the lower limbs and about 9% of all fractures. Sometimes, the medial malleolus may get injured and develop a crack but the bones do not move apart, which is called hairline fracture or stress fracture.
Knowing the causes, symptoms, diagnosis, treatment and recovery time can help in better management of the condition.
Causes of Medial Malleolus Fracture
Medial malleolus fracture or ankle fracture is more common in young men and older women. Causes of medial malleolus fracture mainly include overuse injuries, excessive stress on ankle joints, falls, accidents or injuries to the leg, including sports injuries. Many cases have been related to falls due to alcohol consumption and slippery surfaces. Sports that involve sudden twisting and turning, which can easily injure the ankle resulting in a medial malleolus fracture. Some of the causes of medial malleolus fracture are also related to direct blow to the ankle or its inner side, fall or jumping that results in awkward landing, more on uneven surfaces causing twisting of ankles. It is a common sports injury and medial malleolus fracture can be seen in children too.
Symptoms of Medial Malleolus Fracture
Symptoms of medial malleolus fracture include pain at around medial malleolus or inner side of the ankle. Pain may be worse on turning the ankle inwards or outwards with difficulty in standing or walking. Following an injury, pain and swelling of the area is the commonest symptom of medial malleolus fracture. Bruising or signs of local injury may be noted. In severe fractures, the injured or deformed bones may be noticeable.
Symptoms of medial malleolus fracture caused due to repeated stress or stress fracture generally develop over few weeks. The pain is felt around the ankle joint and at the medial malleolus, which can gradually increase in intensity. Initially, the symptoms of medial malleolus fracture due to repeated injuries or stress are noticeable after activity or exercise.
However, over a period of time, pain may worsen and may be present even after low impact activities like walking and eventually even at rest. The ankle may seem stiff and some swelling may also be noticed. Other symptoms of medial malleolus fracture include limited range of movements, pain on moving or turning the ankle and difficulty in walking.
Diagnosis of Medial Malleolus Fracture
Diagnosis of medial malleolus fracture can be made based on the history, clinical examination and relevant scans. The history often reveals an accident, fall or sports injury, while stress fracture can be suspected in long term slowly increasing pain. Examination reveals pain, tenderness, swelling, which is evaluated to understand if it is a soft tissue injury or a fracture.
Investigations like scans may be ordered, with which, the diagnosis of medial malleolus fracture can be made. A protocol is followed to determine if the injury is a possible fracture or not, based on which an X-ray is ordered. In general, if there is pain and tenderness at the medial malleolus (inner side of ankle region) or if the person is unable to walk due to ankle pain and swelling, a fracture is suspected and X-ray is advisable.
X-ray confirms a break in the bone and also gives an idea about the type and severity of medial malleolus fracture. If other soft tissue damage, ligament injuries or other fractures are suspected, additional scans like CT scan and MRI may be needed.
Treatment of Medial Malleolus Fracture
In case of fresh injury to the ankle joint, which results in a possible medial malleolus fracture, emergency treatment is needed. Resting the joint and elevating the leg is often advisable. Icing can be done for pain and swelling, but is best avoided if there is a severe injury or if a complicated fracture is associated with dislocation.
For suspected fracture, joint reduction is necessary and for any dislocation or damage to surrounding tissues, immediate medical assistance is needed.
Treatment of medial malleolus fracture includes conservative (non-surgical) and surgical approach. Treatment selection depends on the type and severity of the fracture and the condition of the patient. Usually, conservative treatment of medial malleolus fracture, is recommended for less severe and uncomplicated injuries. Fractures that are often not out of place and in patients who are not active, can be managed well with conservative or non-surgical treatment. Conservative treatment may also be advised when the fractured pieces of bones are too small to be repaired surgically.
Conservative treatment of medial malleolus fracture includes the use of removable braces or cast. Usually, weight bearing on the fractured leg is to be avoided for at least 6 weeks, post which, it depends on the healing of the fracture. Regular monitoring and repeated X-rays may be taken to check the healing and to detect any change of position of the fracture.
Depending on the severity and complications of the injury, the treatment of medial malleolus fracture may include surgical correction. Generally surgical treatment of medial malleolus fracture is recommended when the fracture is out of place, the fracture does not heal or there is non-union or when the ankle is unstable. Sometimes, even if the fracture is not out of place, but if there seems a risk of non-union or if the patients are very active, surgery may be considered. Surgery is often performed to align and stabilize the bones. While the type of surgery depends on injury and bone fragments, most surgical corrections are done using screws, plates and wiring options.
Treatment of medial malleolus fracture also includes the use of non-steroidal anti-inflammatory drugs (NSAIDs), for pain management after injury or surgery. Any additional medicines and supplements may also be considered, if appropriate.
Possible complications of surgery of medial malleolus fracture include the risk of infections and delayed healing. Another important risk of medial malleolus fracture is the cartilage damage, which increases the risk of ankle arthritis. People with diabetes, elderly adults and those who smoke may be at greater risk of complications, as the wound healing may be slow in such cases. However, with appropriate timely treatment and effective management, the complications can be minimized and proper recovery can be expected.
Rehabilitation is a necessary part of treatment of medial malleolus fracture. Whether the fracture is treated with conservative or surgical treatment, the appropriate rehabilitation programs promotes better healing and reduces the risk of long term pain and complications. It involves physical therapy to improve the movement of ankle joint and progress through weight bearing and walking. Exercises help to strengthen the supporting muscles, prevent injuries and promote better healing.
Recovery Time For Medial Malleolus Fracture
Recovery time in medial malleolus fracture varies from person to person and depends on the type and severity of the injury and the overall health of the person. However, it takes approximately 6 weeks to heal, while much also depends on the rehabilitation. In cases that need surgery, recovery time may be longer and most people resume their normal activities within 3 to 4 months. However, in some cases, the recovery time may be even longer and some people may continue to limp for months, while it may take time to return to previous fitness level for sports.
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Singh, R., Kamal, T., Roulohamin, N., Maoharan, G., Ahmed, B. and Theobald, P. (2014) Ankle Fractures: A Literature Review of Current Treatment Methods. Open Journal of Orthopedics, 4, 292-303.