The medial malleolus is an anatomical region of thetibia bone, which is the larger of the two lower leg bones. You can feel this area as the bump on the inner side of your ankle joint. It bears 90% of the weight-bearing load, so this is a common fracture. Medial malleolar fractures involve the articular surface of the ankle joint, which is where the bones meet in the joint.
Identifying if fracture ankle surgery is necessary for medial malleolus ankle fractures is usually straightforward. Whether you will need surgery or just casting depends on the severity of the ankle injury. The images below show different fractures. Note: Some images also show associated injuries and before and after results.
Chip FracturesDr. Neal BlitzChip fractures are the sign ofligamentrupture on the inner side of the ankle. Rather than the force of the injury causing a bone break, the ligaments pull off directly where they attach to the bone. The ligament can pull off a small piece of bone as the ligament is ruptured.This chip fracture is also known as anavulsion fracture. They are sometimes seen with simple ankle sprains. The presence of an avulsion fracture, however, may indicate a more severe injury.An avulsion fracture may require a cast or walking boot. In rare cases, if the bone fragment and main bone are too far apart to fuse naturally, surgery may be needed to reunite them. Avulsed bone fragments can be put back into place with fixation screws.
Chip Fractures
Dr. Neal Blitz
Chip fractures are the sign ofligamentrupture on the inner side of the ankle. Rather than the force of the injury causing a bone break, the ligaments pull off directly where they attach to the bone. The ligament can pull off a small piece of bone as the ligament is ruptured.
This chip fracture is also known as anavulsion fracture. They are sometimes seen with simple ankle sprains. The presence of an avulsion fracture, however, may indicate a more severe injury.
An avulsion fracture may require a cast or walking boot. In rare cases, if the bone fragment and main bone are too far apart to fuse naturally, surgery may be needed to reunite them. Avulsed bone fragments can be put back into place with fixation screws.
Transverse FracturesDr. Neal BlitzThe transverse fracture occurs in the same direction as the ankle joint line and is generally a small bone fragment. While these fractures extend into the ankle joint, they do not extend into the weight-bearing portion.Surgery is sometimes needed to stabilize a traverse fracture using cannulated screws. These are screws that are inserted through the skin using a hollow, narrow tube called a cannula.
Transverse Fractures
The transverse fracture occurs in the same direction as the ankle joint line and is generally a small bone fragment. While these fractures extend into the ankle joint, they do not extend into the weight-bearing portion.
Surgery is sometimes needed to stabilize a traverse fracture using cannulated screws. These are screws that are inserted through the skin using a hollow, narrow tube called a cannula.
Oblique FracturesDr. Neal BlitzThe oblique medial malleolar fracture generally occurs along with a rotational injury that starts on the outside of the ankle. It is associated with an oblique fibular fracture and often occurs at the corner of the ankle joint.The presence of an oblique medial malleolar fracture is generally indicative an unstable ankle. Surgery is often recommended rather than casting, utilizing screws as well as wire fixation.It is not uncommon for aruptured Achilles tendonto accompany an oblique fracture, requiringadditional surgeryto repair the torn or severed tendon.
Oblique Fractures
The oblique medial malleolar fracture generally occurs along with a rotational injury that starts on the outside of the ankle. It is associated with an oblique fibular fracture and often occurs at the corner of the ankle joint.
The presence of an oblique medial malleolar fracture is generally indicative an unstable ankle. Surgery is often recommended rather than casting, utilizing screws as well as wire fixation.
It is not uncommon for aruptured Achilles tendonto accompany an oblique fracture, requiringadditional surgeryto repair the torn or severed tendon.
Vertical FracturesDr. Neal BlitzThe vertical fracture usually occurs when the force is oriented more in the leg bone. These fractures can extend into the weight-bearing portion of the ankle joint.Vertical fractures of the medial malleolus may require more than just screws to stabilize the ankle. Oftentimes, fixation is achieved using a narrow metal plate with screws situated on both sides of the fracture line.
Vertical Fractures
The vertical fracture usually occurs when the force is oriented more in the leg bone. These fractures can extend into the weight-bearing portion of the ankle joint.
Vertical fractures of the medial malleolus may require more than just screws to stabilize the ankle. Oftentimes, fixation is achieved using a narrow metal plate with screws situated on both sides of the fracture line.
Comminuted Fractures
Oftentimes, a specialized device called a peg hook plate is used to repair comminuted fractures, allowing the surgeon to position screws in a non-linear pattern. The peg hook plate also accommodates different sized screws, minimizing the risk of further bone fragmentation or the loss of smaller bone chips.
A Word From VerywellIsolated medial malleolar fractures are rare and usually occur in conjunction with lateral malleolar fractures or ligamental/tendon damage. Imaging via X-rays and sometimes CT scans is crucial to determine whether surgery will be necessary. These fractures typically take 6-8 weeks to heal, though pain and swelling may not resolve for up to 6 months.—ANITA C. CHANDRASEKARAN, MD, MEDICAL EXPERT BOARD
A Word From Verywell
Isolated medial malleolar fractures are rare and usually occur in conjunction with lateral malleolar fractures or ligamental/tendon damage. Imaging via X-rays and sometimes CT scans is crucial to determine whether surgery will be necessary. These fractures typically take 6-8 weeks to heal, though pain and swelling may not resolve for up to 6 months.—ANITA C. CHANDRASEKARAN, MD, MEDICAL EXPERT BOARD
Isolated medial malleolar fractures are rare and usually occur in conjunction with lateral malleolar fractures or ligamental/tendon damage. Imaging via X-rays and sometimes CT scans is crucial to determine whether surgery will be necessary. These fractures typically take 6-8 weeks to heal, though pain and swelling may not resolve for up to 6 months.
—ANITA C. CHANDRASEKARAN, MD, MEDICAL EXPERT BOARD
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C.Fractures of the ankle joint: investigation and treatment options.Dtsch Arztebl Int.2014;111(21):377-88. doi:10.3238/arztebl.2014.0377Shur V, Georgiev K.Stabilization technique for comminuted medial malleolus fractures.Techniques Orthop.2015 Dec;30(4):259-61. doi:10.1097/BTO.0000000000000095Lu J, Maruo Holledge M.Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon.J Surg Case Rep. 2016;2016(4). doi:10.1093/jscr/rjw062Lampridis V, Gougoulias N, Sakellariou A.Stability in ankle fractures: diagnosis and treatment.EFORT Open Rev.2018;3(5):294-303. doi:10.1302/2058-5241.3.170057Hidden KA, Jamieson MD, Groth AT.Utilizing the locking peg hook plate for a comminuted fracture of the medial malleolus.J Orthop Trauma.2019;2019;e1-4. doi: 10.1097/BOT.0000000000001591
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C.Fractures of the ankle joint: investigation and treatment options.Dtsch Arztebl Int.2014;111(21):377-88. doi:10.3238/arztebl.2014.0377Shur V, Georgiev K.Stabilization technique for comminuted medial malleolus fractures.Techniques Orthop.2015 Dec;30(4):259-61. doi:10.1097/BTO.0000000000000095Lu J, Maruo Holledge M.Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon.J Surg Case Rep. 2016;2016(4). doi:10.1093/jscr/rjw062Lampridis V, Gougoulias N, Sakellariou A.Stability in ankle fractures: diagnosis and treatment.EFORT Open Rev.2018;3(5):294-303. doi:10.1302/2058-5241.3.170057Hidden KA, Jamieson MD, Groth AT.Utilizing the locking peg hook plate for a comminuted fracture of the medial malleolus.J Orthop Trauma.2019;2019;e1-4. doi: 10.1097/BOT.0000000000001591
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C.Fractures of the ankle joint: investigation and treatment options.Dtsch Arztebl Int.2014;111(21):377-88. doi:10.3238/arztebl.2014.0377Shur V, Georgiev K.Stabilization technique for comminuted medial malleolus fractures.Techniques Orthop.2015 Dec;30(4):259-61. doi:10.1097/BTO.0000000000000095Lu J, Maruo Holledge M.Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon.J Surg Case Rep. 2016;2016(4). doi:10.1093/jscr/rjw062Lampridis V, Gougoulias N, Sakellariou A.Stability in ankle fractures: diagnosis and treatment.EFORT Open Rev.2018;3(5):294-303. doi:10.1302/2058-5241.3.170057Hidden KA, Jamieson MD, Groth AT.Utilizing the locking peg hook plate for a comminuted fracture of the medial malleolus.J Orthop Trauma.2019;2019;e1-4. doi: 10.1097/BOT.0000000000001591
Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C.Fractures of the ankle joint: investigation and treatment options.Dtsch Arztebl Int.2014;111(21):377-88. doi:10.3238/arztebl.2014.0377
Shur V, Georgiev K.Stabilization technique for comminuted medial malleolus fractures.Techniques Orthop.2015 Dec;30(4):259-61. doi:10.1097/BTO.0000000000000095
Lu J, Maruo Holledge M.Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon.J Surg Case Rep. 2016;2016(4). doi:10.1093/jscr/rjw062
Lampridis V, Gougoulias N, Sakellariou A.Stability in ankle fractures: diagnosis and treatment.EFORT Open Rev.2018;3(5):294-303. doi:10.1302/2058-5241.3.170057
Hidden KA, Jamieson MD, Groth AT.Utilizing the locking peg hook plate for a comminuted fracture of the medial malleolus.J Orthop Trauma.2019;2019;e1-4. doi: 10.1097/BOT.0000000000001591
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