Lateral Malleolus Fracture

Lateral Malleolus Anatomy

The ankle joint is made up of 3 bones, the medial malleolus, lateral malleolus, and the talus bone. The lateral malleolus sits on the outside of the ankle joint and absorbs approximately 10% of your weight in standing. It is the most common of the ankle joints to fracture. Lateral Malleolus Fractures are generally stable fractures but traumatic events such as a fall or trip can lead to an unstable fracture.

In this article, we will discuss the most common types of Lateral Malleolus Fractures, conservative treatment, and surgical treatment.

Lateral Malleolus Fracture Symptoms

Swelling and bruising over the lateral ankle
Pain on weight-bearing, walking or hopping
Pain when walking on uneven surfaces
A caveat to this is that we often see patients with little to no pain on walking as low levels of body weight go through the lateral malleolus when walking.

Lateral Malleolus Fracture Types:

Weber B Fracture

This is a fracture at the ankle level of the lateral malleolus but may extend up the fibula. It can involve the ligaments attaching to the fibula and can be stable or unstable.

Displaced Fracture

This is when a gap appears in the bone at the site of the fracture and these often require surgical repair

Epiphyseal Fracture

This is a type of fracture involving the growth plate and is common in children

Flake or Avulsion Fracture

This is where the ligament is pulled off the bone and in doing so it can pull some flakes or fragments of the bone off with it.

Lateral Malleolus Fracture with syndesmotic disruption

The syndesmosis attached the tibia and fibula together, this becomes torn or compromised with this type of fracture.

$Scan of fibula fracture$

Causes

Poor biomechanics
Poor Footwear
Ankle Sprains
Falls and Trips
Repetitive overload through impact activities such as running.
Trauma such as impact to the ankle joint

Diagnosis & Radiology

A consultation with a Physical Therapist, Podiatrist, or Sports Medicine Doctor is recommended if you have any of the symptoms of a Lateral Malleolus Fracture. A clinical interview of your symptoms alongside a clinical examination can often be sufficient to achieve a diagnosis for your therapist. A clinical examination will often involve a hop test and tap test.

This is normally followed by imaging to rule out other conditions and to confirm the diagnosis. An x-ray is the primary imaging model but if this returns as normal, a referral for an MRI or Ct Scan may be required. An ultrasound scan is rarely used for this type of injury.

Lateral Malleolus Fracture Conservative Treatment

A stable Lateral Malleolus Fracture is usually managed with 4-6 weeks in a walker boot. Historically a cast was used but the walker boot allows for greater function and equivalent healing response.

During this time period, Physical Therapy can begin to maintain the mobility of the surrounding tissues such as the Calf, Peroneal, and Posterior Tibialis muscles. Upon removal of the boot, rehabilitation can last for 4-6 further weeks. This involves strengthening and mobility exercises of the foot and ankle. Graded exposure to impact activities and return to play protocols if you wish to return to sport. Rehabilitation exercises are similar to that of a sprained ankle.

Taping and/or an ankle brace may be used when returning to activities that require a change of support, especially for those with unstable ankles. Surgery is not usually required for a stable fracture.

Scan of post operative ankle fixation

Lateral Malleolus Fracture Surgery

For unstable Lateral Malleolus Fractures or a malunion, surgery may be required. This is often an ORIF that can involve the use of metalwork such as a plate to provide stability to the broken bone. You may require the use of a walker boot after surgery and rehabilitation with a Physical Therapist can last for 6-12 weeks.

Post-operative complications include nerve damage if a nerve is cut during the procedure but these surgeries are generally very successful overall.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.