Medial malleolus avulsion fracture

Case contributed by Dr Henry Knipe

Presentation

Twisted ankle in fall.

Patient Data

Age: 30 years
Gender: Male

Anteromedial soft tissue swelling. Small ankle joint effusion. Mildly displaced avulsion fracture from the tip of the medial malleolus in keeping with a deltoid ligament injury. Small fleck lying posterior to the posterior malleolus may represent a further avulsion fracture. Anterior distal tibial spurring. 

Case Discussion

Deltoid ligament injuries, be it sprain, tear, or avulsion, are much less common than lateral collateral or syndesmotic injuries. Here, it is possible for further ligamentous injuries, especially at the posterior malleolus given the small bone flake suspicious for a PITFL injury. A proximal fibular injury (i.e. Maisonneuve fracture) should always be considered a deltoid / medial malleolus injury. 

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