Treatment of Medial Malleolus Fractures

Assessment of Fracture Stability

Weight-bearing radiographs provide crucial information about fracture stability, which is the most important criterion in determining treatment approach, as recommended by the American College of Radiology 1
A medial clear space of <4 mm confirms stability of the fracture, according to the American College of Radiology 1
Standard radiographic protocol should include anteroposterior, lateral, and mortise views to properly assess the fracture, as suggested by the American College of Radiology and other guidelines 1, 2
MRI without IV contrast is valuable for assessing associated bone marrow contusions and soft-tissue abnormalities when radiographs are inconclusive, as noted by the American College of Radiology and Praxis Medical Insights 2

Indicators of instability requiring surgical intervention include medial tenderness, bruising, or swelling, as recommended by the American College of Radiology 1
High-energy fracture injury is also an indicator of instability requiring surgical intervention, according to the American College of Radiology 1

Regular radiographic follow-up is essential to ensure proper healing and alignment, as recommended by the American College of Radiology 1
MRI may be used to confirm complete healing in cases where radiographs are inconclusive, as suggested by Praxis Medical Insights 3

Fractures may be overlooked on routine radiographs; special attention to areas of tenderness is recommended, as noted by Praxis Medical Insights 2
Untreated fractures can lead to functional limitations and post-traumatic arthritis, according to Praxis Medical Insights 2
Patients with osteoporosis may require extended immobilization, as suggested by Praxis Medical Insights 3