Stress fractures of both medial malleoli

Case contributed by Dr Michael Rayner

Presentation

Incidental finding of bialteral ankle fractures in a patient presenting for bilateral knee arthritis for consideration for arthoplasty.

Patient Data

Age: 65 years
Gender: Female

Undisplaced fractures of the left and right medial malleoli are present in a vertical-oblique pattern. Some evidence of callus formation is evident and the two fractures appear to be of different ages. 

Relatively symmetrical, advanced medial compartment osteoarthritis is seen with significant varus alignment to the knees.  

Case Discussion

Incidental finding of stress fractures of both medial malleoli was detected. The patient had a history of severe varus osteoarthritis of the knees likely contributing to the mechanical stress on the medial malleoli. There were bilateral symmetrical fracture patterns with no history of trauma.

The patient did not have a known history of osteoporosis but a recommendation for assessment would be advisable.  Other potential endocrine anomalies that make contribute to stress/insufficiency fractures should also be assessed for.  

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