Isolated Medial Malleolus Fracture

Abstract

Fractures of the medial malleolus represent Salter-Harris III fractures that occur as a result of a supination-inversion mechanism at an average age of between 11 and 12 years. These can be isolated medial malleolus fractures (approximately 75% of cases) or can have an associated distal fibula fracture (25% of cases). Treatment is dictated by the amount of fracture displacement, with greater than 2 mm of residual displacement following closed reduction meeting the criteria for open reduction and internal fixation. In nondisplaced or minimally displaced fractures, treatment consists of a nonweightbearing long leg cast for 4 weeks followed by an additional 4 weeks in a short leg cast. For displaced fractures, operative management results in excellent restoration of the articular surface, but these fractures carry a significant risk of complications. Patients should be followed over the long-term to evaluate for physeal arrest, angular deformity, or leg length discrepancy, which may occur in 11–15% of patients. These complications may develop in operatively or nonoperatively treated fractures and may be related to the amount of initial fracture displacement or the quality of reduction.