Malleolus Fractures

Overview

Malleoli (sing. malleoli) are the bony protuberances of the tibia (shinbone) and the fibula at its lower end. Malleoli are part of ankle joint, and present on its three sides to provide support. Hence there are three malleoli, namely the medial (inner) malleolus, posterior malleolus and the lateral (outer) malleolus. Literally, the word ‘malleolus’ means ‘small hammer’ in Latin.
Malleoli are clinically important because these are the common sites of fracture due to trauma and can lead to complications of other contents within and adjacent to the ankle. A fracture can range in size and number of bones and ligaments damaged. Tearing of one or more ligaments can seriously impair the ability to move for the patient. Usually, it takes around 6 weeks for treatment of malleolus fracture without surgery, but may take longer if more tendons and ligaments are involved.

Causes

Common causes of malleolus fracture may include following:-

  1. Forceful twisting of the ankle joint as in sports
  2. Falling on ankle joint
  3. Accident/Trauma, for e.g. Road traffic accidents

Common Signs & Symptoms

  1. Swelling (inflammation) of the injured area
  2. Collection of blood in the injured tissues (Hematoma)
  3. Pain, especially upon touch (tenderness)
  4. Difficulty in walking or attempting to walk accompanied by severe pain
  5. Deformed and unbalanced structure of the ankle
  6. Redness of the injured area

Investigation – Radiographic Imaging

X-rays and MRIs reveal a great deal about malleolus fractures:-

  • X-rays: X-rays are the most commonly used investigating tool for malleolus fracture, and other bone disorders and join fractures. The procedure can expose broken sections and dislocation of bones.
  • MRI: X-rays show all of the bony parts, however, an MRI can fully reveal the extent of damage done to soft tissues, like ligaments, tendons and muscles. Likewise, treatment strategy is then devised to reduce and fix the damaged areas.

Types Of Malleolus Fractures

There are five types of malleolus fracture depending on type of malleolus and the number of malleoli fractured:

  1. Lateral Malleolus Fracture: Lower end of the fibula is fractured. Non-surgical treatment may take up to 6 weeks of recovery time. However, if dislocation is detected in X-ray, surgery is advised to realign and reposition the fracture together. It may be classified further into types A, B and C, depending on the level of fractures.
  2. Medial Malleolus Fracture: It is the fracture of the lower end of tibia (shinbone). Treatment strategy is the same as performed in lateral malleolus fractures.
  3. Posterior Malleolus Fracture: It is the fracture of the tibia (shinbone) on the posterior side in which chances of lateral malleolus fracture are very high as well due to the common ligaments shared between them. It is typically treated by surgery and always needs prompt attention, since it this fracture can lead to arthritis
  4. Bimalleolar (Two Malleoli) Fracture: The two most commonly fractured malleoli together are lateral and medial ones in addition to the damage done to inner ligaments of the ankle joint.
  5. Trimalleolar (Three Malleoli) Fracture: All three of the malleoli are fractured namely the lateral, medial and posterior malleoli.

Treatment

Treatment of malleolus fracture always comprises of one of the two options depending upon dislocation and area of bone(s) damaged. Recovery time is usually 6-8 weeks.

  • Surgical: Surgery is performed in case the joint is out of place (dislocated).
  • Non-Surgical: Medical treatment is started when no dislocation is present. Placement of a cast and bed rest for any type of malleolus fracture is done in order to stabilize the damaged bones.

Sources

https://www.verywell.com/lateral-malleolus-fracture-2549417

https://aotrauma.aofoundation.org/Structure/…/Malleolar%20fractures_Handout.pdf

http://orthoinfo.aaos.org/topic.cfm?topic=a00391