Lateral Malleolus Fracture


Introduction

The most common joint that is injured in playing sports is the ankle and this may cause pain in the affected leg. There are 3 bones that makes up the ankle joint and the lateral malleolus is the area that is the most frequently fractured part of the ankle [1, 2].

What is Lateral Malleolus?

The ankle joint is composed of the fibula, tibia, and talus bones and they are held together by the joint capsule and the ligaments that surrounds it. The distal end of the fibula is the medial malleolus while the distal end of the fibula is the lateral malleolus. The surface of the tibia that carries the most weight and the medial and lateral malleolus is covered with cartilage. Ankle stability is provided by these structures and the ligaments found in this area [1, 2, 3].

Lateral Malleolus image


posterior medial Malleolus

Figure 1 shows the diagram of the lateral malleolus

A lateral malleolar fracture occurs as a result of the twisting of the foot or ankle resulting from tripping or falling. The more bones that may be broken after the incident, the more unstable the ankle may become and the ligaments may be damaged as well [2, 3, 4].


Lateral Malleolus Fracture photo

ICD10

The ICD-10-CM diagnosis code for the fracture of the lateral malleolus is S82.6. It can be further classified into whether there is a displacement of the ankle [5].

Causes

This type of ankle fracture usually happens after a rolling of the ankle combined with weight bearing force. A lateral malleolus injury may also be obtained from an improper landing following a jump or an impact from the outer ankle such as from a vehicular accident. Players who engage in sports that involves changing of direction while running are very prone to this. Examples of these sports are basketball, netball, soccer, football and rugby [3, 4, 6].

Signs and symptoms

After sustaining the injury, the individual will experience a sharp, intense pain on the outer ankle or the lower leg. This may have cause the leg to be unable to bear weight and may cause the person to limp. The pain may usually turn into an ache that may intensify in the morning [2, 6].

The pain should be confined to the outer ankle because any pain outside of this area may indicate a more serious injury. If pain is present on the inner side of the ankle, there is a possibility that an injury called bimalleolar equivalent fracture that greatly affects the stability of the ankle and may require a surgery to resolve [2, 6].

Other signs that may be present are swelling and bruising on the site and it will be tender to touch. There are also reports of pins and needles sensation or numbness in the affected ankle. Ankles that have been displaced due to the injury may show a deformity on the joint [6].


Diagnosis

History & physical examination

In obtaining the medical history, identifying the mechanism of the injury will help the physician assess the stability of the ankle. Any ankle that is unable to bear weight should undergo a radiographic examination for further assessment. Physical examination will include inspection and palpation of the ankle. The range of motion and strength of the injured ankle will also be tested by the physician [2, 6].

Imaging tests

The X-ray is the most common imaging technique that is done. It will be able to show if the bone has been broken and if the ankle has been displaced. A Computerized Tomography (CT) scan and a Magnetic Resonance Imaging (MRI) scan may be requested if the ligaments have been suspected to be damaged as well [4].

Lateral Malleolus Fracture Treatment

Healing Time

A surgery may not be required if the ankle is still stable and no bone has been displaced. Weight bearing on the injured ankle may be advised to be avoided and it should be protected while it is healing. It would usually take around 6 weeks for the ankle to heal [4, 6].

Surgery

A displaced ankle may require a surgical treatment for management. In this procedure, the fragments of the ankle joint are repositioned into the normal alignment. Special screws and metal plates may be used to hold them together and it will be attached to the bone’s outer surface [4, 6].

Lateral Malleolus Fracture Surgery Lateral Malleolus Fracture surgery repair

Lateral Malleolus Fracture surgery internal fixation


References

  1. Kelly, J. I. (2015, October 21). Ankle Fracture in Sports Medicine Clinical Presentation. Retrieved from eMedicine: http://emedicine.medscape.com/article/85224-clinical#b4
  2. Cluett, J. (2016, January 24). Lateral Malleolus Fracture. Retrieved from About Health: http://orthopedics.about.com/od/footankle/fl/Lateral-Malleolus-Fracture.htm
  3. Department of Orthopaedic Surgery. (2015). Ankle Fracture. Retrieved from Department of Orthopaedic Surgery, University of California: http://orthosurg.ucsf.edu/patient-care/divisions/sports-medicine/conditions/ankle-and-foot/ankle-fracture/
  4. Crist, B. (2013, March). Ankle Fractures (Broken Ankle). Retrieved from Ortho Info: http://orthoinfo.aaos.org/topic.cfm?topic=a00391
  5. ICD10 Data. (2015). Fracture of lower leg, including ankle. Retrieved from ICD10 Data: http://www.icd10data.com/ICD10CM/Codes/S00-T88/S80-S89/S82/S82.6-
  6. Physio Advisor. (2014). Lateral Malleolus Fracture. Retrieved from Physio Advisor: http://www.physioadvisor.com.au/13157250/lateral-malleolus-fracture-physioadvisor.htm

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