Fracture of the posterior malleolus: an underdiagnosed condition


  • Luís D. Silva ULS-Guarda, Guarda, Portugal; Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Portugal; Spine Center- Sanfil, Coimbra, Portugal; Clínica Medicina Física e Reabilitação, Seia, Portugal
  • Bruno Maia ULS-Guarda, Guarda, Portugal; Spine Center- Sanfil, Coimbra, Portugal
  • Eduardo Cruz Ferreira ULS-Guarda, Guarda, Portugal
  • Filipa Pires ULS-Guarda, Guarda, Portugal
  • Luís Camarinha ULS-Guarda, Guarda, Portugal



Fracture, Posterior malleolus, Differential diagnosis, Radiography, Ankle


The ankle joint is the most commonly injured joint during sports activity. While ankle sprains occur more frequently, ankle fractures are less common. Due to its low incidence, the isolated fracture of the posterior malleolus still represents a diagnosis challenge. This article reports a case of a female with a posterior malleolus isolated fracture after falling while performing sports activity. Clinical examination and conventional radiography were consistent with diagnosis of a simple ankle sprain and the patient was discharged with a conservative approach for lateral ankle sprain. Due to persistent pain the patient return for additional examination, which the differential diagnosis revealed an isolated fracture of the posterior malleolus without displacement of the fragment. The patient was immobilized with a suropodalic splint for 4 weeks followed by additional conservative. At the fourth month of follow-up, the patient was asymptomatic and showed good clinical and functional outcomes. This case highlights the importance of a comprehensive medical history and detailed clinical examination which may reveal pathological features that require a differential diagnosis.


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