Medial Malleolar Stress Fracture in Athletes: Diagnosis and Operative Treatment

Abstract

Background and Aims: stress fractures are common overuse injuries in athletes. Medial malleolar stress fractures are rare but they have an important clinical relevance because of their tendency to cause considerable disability and loss of time in sports without proper treatment. the diagnosis of medial malleolar stress fracture is often a challenge and it is therefore often delayed which may cause even further problems in the treatment. the purpose of this study was to increase the awareness of medial malleolar stress fractures as a possible cause for medial ankle pain and to stress the importance of Mri in the diagnostics as well as to evaluate the results of surgical treatment.Patients and Methods: between 1995 and 2008, a total of ten athletes with a medial malleolar stress fracture were operated at our centre. all operated cases during those years were included in the study. the cases were retrospectively analyzed. return to preinjury level of sport was evaluated and considered as an indicator of successful treatment.Results: initially all standard radiographs were negative whereas in Mri the fractures were all visible. after operative treatment all medial malleolar stress fractures healed clinically in three to four months and all except one of the athletes were able to return to their pre-injury level of sports.Conclusion: early Mri is recommended if a medial malleolar stress fracture is suspected. surgical treatment seems to result in rapid healing of the fracture and return to sports. in our opinion early surgery should be considered especially in athletes.

Double Threaded Screw Fixation for Bilateral Stress Fracture of the Medial Malleolus

“…In Orava's case series, five of the eight patients were successfully managed with conservative treatment while surgery was required for three patients with fractures with displacement or delayed healing. A recent article by these authors (Orava et al) in 2012 reported a clinical course of 10 patients who underwent surgery for this injury [11]. Among the 10 patients included in this case series, surgery was indicated for five patients after failed attempts of conservative treatment.…”

Medial Malleolar Insufficiency Fracture of the Ankle in an Elderly Patient with Osteoporosis

“…The leading clinical symptoms in patients with an insufficiency fracture is pain, and this may be worse with loading and increased physical activity. [9] Radiographs are still the most widely used imaging methods for identification of insufficiency fractures, but the sensitivity is limited. MRI is the diagnostic agent of choice due to its higher sensitivity and specificity, and it allows the differentiation of benign versus malignant fractures.…”

Basketball Injuries

“…Medial malleolus stress fractures are rare, accounting for anywhere between 0.6% and 4.1% of stress fractures (40). Again the repetitive jumping makes basketball players a more common population for these injuries (40).…”

“…Again the repetitive jumping makes basketball players a more common population for these injuries (40). Radiographs should be performed initially; however false negatives have been reported 70% of the time (40), and radiographic evidence may not be present for 2 to 4 wk. The typical location of these injuries is at the junction of the medial malleolus and tibial plafond.…”

“…The typical location of these injuries is at the junction of the medial malleolus and tibial plafond. A longer treatment regimen has been reported with a period of 4 to 5 months of nonoperative treatment, then followed by a return to sport protocol (40). Therefore follow-up imaging with MRI or bone scan is recommended when there is clinical suspicion.…”