Presentation
Patient presented to the ED due to pain in the region of the medial malleolus. Mechanism: kicking injury to the right ankle, sustained while playing football. Upon examination profound sensitivity in the region of the medial aspect of the ankle.
Patient Data
A subtle lucency could be observed in the anteroposterior radiograph at the base of the medial ankle, however no immediately evident fracture line could be visualized. Considering the strong suspicion of medial malleolar injury further oblique radiographs were requested.
In the semi-oblique anteroposterior radiograph a hairline fracture could be clearly discerned at the base of the medial malleolus.
Case Discussion
Isolated fractures of the medial malleolus are realtively infrequent form of ankle fractures. Basically, this type of injury occurs typically due to a "pull-off" effect of the medial collateral ligament. More precisely, according to the Lauge-Hansen classification system of ankle injuries this kind of fracture is mostly a result of a forced abduction or external rotation of the ankle, sustained in a pronated position.
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