A straight oblique fracture throught the medial malleolus (left) was repaired with percutaneous minimally invasive surgery with two surgical screws (right) that allow reductions and better healing of the fracture. This also will secure the ankle joint along the fracture site to reduce the risk of arthritis at a later time.
Medial malleolar fractures result from direct impact to the talus or from tension as the talus rotates or moves laterally following the fibula. A medial malleolar equivalent fracture is when the deep fibers of the deltoid ligament tear, but the bone remains intact. The anterior colliculus portion of the medial malleolus may be avulsed by the superficial fibers of the deltoid ligament. The deep fibers may remain intact or rupture. A fracture above the level of the ligamentous attachment leaves the deltoid ligament attached to the distal malleolar fragment. If non-displaced and no other associated fracture, these can be treated sometimes non-surgically with a nonweightbearing cast followed by Cam Walker and physical therapy. If displaced, then surgery is required to make the fracture anatomic. Usually, at least two types of fixation will be utilized to reduce any rotation. Fixation includes screws, screw and/or pin, pins or tension band if applicable.
The x-rays below demonstrate both pre and post-operative repair of a medial malleolar fracture. The surgical repair was performed with open reduction and internal fixation of the fracture fragments with two surgical screws.
Pre and Postop X-rays of medial malleolus fracture ORIF
Pre and Postop Xrays of ORIF Medial Malleolus Fracture
Pre and Postop Medial Malleolus Fracture with Screw Fixation
Pre and Postop Medial Malleolus Fracture with Minimally Invasive Percutaneous Screw Fixation
78 year old with footdrop and neuropathy with distal tibia (Medial Malleolus) Fracture and Fibula Fracture Treated with Minimal Invasive Percutaneous Screw Fixation
Preop and Postop Medial Malleolus Fracture with K Wire Fixation
Below, Preop Displaced Pilon Fracture
Below, After Ex Fix was placed to stabilize and temporarily reduce fracture
Below, Ex Fix is removed and ORIF performed. Reduction of fracture is complete.
The following images are CT scans in different planes illustrating the fracture of the medial malloelus that does not have significant displacement.
The CT scans below show a medial malleolar fracture that is comminuted with displacement that does neccesitate surgical repair for adequate healing and avoidance of long term complications.
Xray, MRI and CT Scan of non displaced subtle medial malleolus stress fracture
Intraop Arthroscopic Pic of Intra-articular Medial Malleolus/Distal Tibia Fracture. The Fracture line can be seen at the tibia at the top of the pic during ankle joint arthroscopic assisted minimal invasive percutaneous screw fixation.
Intraop Pic of COmminuted DIstal Tibia Fracture and Medial Malleolus Fracture during ORIF. The two pins on the bottom are in the medial malleolar fracture fragent prior to reduction and fixation.