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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Is surgery required for a medial malleolar fracture of the left tibia?

Answered by
Dr.
Dr. Aashish Raghu

Orthopaedic Surgeon

Practicing since :2011

Answered : 5177 Questions

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Posted on Fri, 30 Nov 2018 in Back Pain
Question: I was diagnosed with a medial malleolar fracture of my left tibia following a skiing accident. Based on the ED evaluation, the fracture was non-displaced at the time and "likely would not require surgery". There are two views, one more oblique than the other, the latter of which shows a slightly more displaced fracture. I am 5 days out from the injury and am in a short leg cast. I am in discomfort, and have generally babied the ankle, but have had the occasional unavoidable knock into a door frame, etc, while navigating with crutches.

I was hoping to have a second look at the original x-ray (mindful of the fact that I will be returning in less than a week for more imaging to determine the need for surgery, which the PA-C suggested would not be likely if everything stayed in place. I will try to attach the relevant files. What are thoughts on surgery for this type of fracture? I am a 32 year old male who leads an active lifestyle. I want to be able to return to my fitness routine (and skiing), but also need to be able to return to weight bearing as soon as safely possible for my job.

Assuming nothing moves, and the x-ray stays as pictured, what are general thoughts on the appropriateness of surgical reduction? Finally, I've read about impaction and indentation. Based on these films, is this a factor herein?

Kind regards.
doctor
Answered by Dr. Aashish Raghu 1 hour later
Brief Answer:

Answers to your queries

Detailed Answer:

Hi,

I have read your query and viewed the attached X-rays.

Surgery is usually indicated in this type of fracture but since it is undisplaced, Conservative management can be done.

Since the fracture is undisplaced, surgical reduction is not indicated.

You will need to be on the non-weight bearing for 4 weeks and then gradually tip-toe weight bearing can be started as tolerated and in accordance with the healing progress.

You can return to work and skiing once the fracture has united, which usually takes 6-12 weeks. Serial X-rays can help your Surgeon decide when.

The fracture fragments can be said to have impacted with each other which is beneficial as it will facilitate healing.

Hope I have answered your query.

Take care

Regards,
Dr Aashish Raghu, Orthopaedic Surgeon
Above answer was peer-reviewed by : Dr. Kampana
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