DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20220617
Published: 2022-02-25

Concomitant bilateral medial malleolus stress fracture: a case report and review of literature of an extremely rare injury

Vivek Mathew Philip, Raj Shekhar, Saurabh Sharma, Prashant Pratim Padhi

Abstract


Medial malleolus stress fractures are rare stress injuries and account for 4% of all the stress fractures. Bilateral medial malleolus stress fracture (MMSFs) is extremely rare with only five such cases reported in existing literature. We report an extremely rare injury pattern in the form of concomitant bilateral MMSF in a young military recruit who presented with severe pain in both his ankles for one month. A 20-year military recruit undergoing rigorous physical training presented to us with severe bilateral ankle pain of one month duration. Clinico-radiological examination revealed bilateral MMSFs. He was managed with open reduction and internal fixation using a one-third tubular plate in buttress mode. Patient was gradually rehabilitated and on one-year follow up, he is asymptomatic and performing all strenuous physical activities. Bilateral MMSFs are extremely rare injuries with only five such cases reported in existing medical literature and this is the fourth instance where bilateral MMSFs were diagnosed at the time of clinical presentation and managed simultaneously, in the same surgical setting.

 


Keywords


Stress fracture, Medial malleolus, Bilateral, Concomitant

Full Text:

PDF

References


Nguyen A, Beasley I, Calder J. Stress fractures of the medial malleolus in the professional soccer player demonstrate excellent outcomes when treated with open reduction internal fixation and arthroscopic spur debridement. Knee Surg Sports Traumatol Arthrosc. 2019;27:2884-9.

Orava S, Karpakka J, Taimela S, Hulkko A, Permi J, Kujala U. Stress fracture of the medial malleolus. J Bone Joint Surg Am. 1995;77:362-5.

Anderson RB, Hunt KJ, McCormick JJ: Management of common sports-related injuries about the foot and ankle. J Am Acad Orthop Surg. 2010;18:546-56.

Irion V, Miller TL, Kaeding CC. The treatment and outcomes of medial malleolar stress fractures: a systematic review of the literature. Sports Health. 2014;6:527-30.

Lempainen L, Liimatainen E, Heikkilä J, Alonso J, Sarimo J, Mattila K et al. Medial malleolar stress fracture in athletes: diagnosis and operative treatment. Scand J Surg. 2012;101:261-4.

Steckel H, Klinger HM, Baums MH, Schultz W. Beidseitige stressfraktur des malleolus medialis,” Sportverletz Sportschaden. 2005;19(1):41-5.

Kanto R, Fukunishi S, Marooka T, Seino D, Takashima T, Yoshiya A et al. Double threaded screw fixation for bilateral stress fracture of the medial malleolus. Case Rep Orthop. 2014;729035.

Klavas DM, Holderread BM, Liu J. Bilateral Medial Malleolus Stress Fractures in a High School Athlete Treated with Open Reduction Internal Fixation. Cureus. 2021;13(9):e18186.

Reider B, Falconiero R, Yurkofsky J. Non-union of a medial malleolus stress fracture. A Case Report. Am J Sports Med. 1993;21:478-81.

Boden BP, Osbahr DC. High-risk stress fractures: evaluation and treatment. J Am Acad Orthop Surg. 2000;8:344-53.

Ashish S, Samuel V, Kurt H, Aaron N. Bilateral medial malleolus stress fractures due to osteoarthritis of knee: A case report and review of literature. Int J Surg Case Rep. 201;6C:2014;266-8.

Looze CA, BS, Golden B, MD, Egol KA. Bilateral Fractures of the Medial Malleoli Without a History of Trauma.Am J Orthop. 2009;38(5):237-40.