Medial / Lateral Malleolar Fracture

A medial or lateral malleolar fracture refers to a break in one of the two bony prominences of the ankle. These malleoli are part of the lower leg bones that form the ankle joint:

1. The lateral malleolus is the end of the fibula (outside of the ankle)
2. The medial malleolus is the end of the tibia (inside of the ankle)

These fractures are commonly seen after twisting injuries, falls, or high-impact trauma and may occur in isolation or as part of a more complex ankle fracture.

Types of Medial/Lateral Malleolar Fractures and Mechanism of Injury

Medial and lateral malleolar fractures typically:

1. Occur individually (isolated fractures) or together as part of bimalleolar or trimalleolar injuries.
2. May be stable or unstable, depending on whether the surrounding ligaments and ankle joint alignment are affected
3. Can involve displacement of the bone fragments or remain aligned (non-displaced)

The mechanism of injury:

Most of these fractures occur from rotational forces, such as the foot twisting inward or outward relative to the leg. Common causes include:

1. Sports injuries
2. Slipping or falling on uneven surfaces
3. High-energy trauma, for example, motor vehicle accidents

Ligament injuries often occur alongside malleolar fractures. The occurrence of ligament injuries will influence treatment decisions due to the increased risk of ankle joint instability.

Symptoms and Diagnosis of a Medial/Lateral Malleolar Fracture

Common symptoms seen include:

1. Sudden, sharp pain at the inner or outer side of the ankle
2. Swelling and bruising, often localised over the fracture site
3. Inability to bear weight
4. Bone tenderness when pressing on the malleolus
5. Occasionally, a visible deformity in more severe or displaced fractures

Diagnosis

Diagnosis begins with a clinical examination and history to understand the mechanism of injury. X-rays of the ankle are used to:

1. Confirm the fracture location
2. Assess for displacement or joint involvement
3. Evaluate ankle stability

Weight-bearing X-rays (if tolerated) and, in some cases, a CT scan may be requested if the joint surface or posterior ankle is involved or to assist in surgical planning.

Treatment Approaches for a Medial/Lateral Malleolar Fracture

Treatment depends on several factors, including:

1. Whether the fracture is displaced or stable
2. If the ankle joint is involved
3. The integrity of the surrounding ligaments, especially the syndesmosis

Non-surgical treatment is typically recommended for:

1. Stable fractures with good alignment

Management involves:

1. A moon boot or short leg cast
2. Weight-bearing as tolerated or limited, depending on fracture type
3. Regular follow-up with X-rays to ensure the fracture remains stable

Surgical treatment is recommended if:

1. The fracture is displaced
2. There is joint instability or malalignment
3. There is associated syndesmotic or posterior malleolar injury

Surgery may involve ORIF, using plates and screws to restore joint alignment and allow for early rehabilitation.

Prognosis for a Medial/Lateral Malleolar Fracture

Most medial or lateral malleolar fractures heal well with appropriate management.

1. Bone healing typically takes 6–8 weeks
2. Return to full activity may take up to 3 months, depending on the fracture and treatment
3. Physiotherapy may be needed to regain strength, ankle motion, and balance

Complications are uncommon. However, some patients experience chronic pain, stiffness, or post-traumatic arthritis, particularly in cases with joint surface damage or delayed treatment.

Role of Access Ortho in Diagnosing and Treating Medial/Lateral Malleolar Fractures

At Access Ortho, we provide efficient and expert care for medial and lateral malleolar fractures. Whether you’ve just injured your ankle or have already attended the emergency department, we’re here to guide your treatment and recovery.

Our services include:

1. No-referral appointments
2. Rapid appointments
3. X-ray referral and review for immediate diagnosis
4. Fitting of moon boots or splints at your first visit
5. Referral if surgery is required
6. Comprehensive follow-up care, including review of new imaging
7. Return-to-work or sport planning tailored to your injury