Sequential Vertical Shear Fractures of the Medial Malleolus in a High School Football Player: A Case Report and Literature Review

in International Journal of Athletic Therapy and Training

Click name to view affiliation

Sravya Vajapey The Ohio State University Wexner Medical Center

Search for other papers by Sravya Vajapey in
Current site
Google Scholar
PubMed Close
*
and
Timothy L. Miller The Ohio State University Wexner Medical Center

Search for other papers by Timothy L. Miller in
Current site
Google Scholar
PubMed Close
*
DOI:
https://doi.org/10.1123/ijatt.2019-0094
Keywords:
bilateral; medial malleolar fracture; ORIF
First Published Online:
27 Mar 2020
In Print:
Volume 25: Issue 4
Page Range:
185–189
Restricted access

We report a case of bilateral vertical shear (pilon variant) medial malleolar fractures in a high school football player that occurred 1 year apart. The player was able to return to his sport after surgical fixation. Treatment of ankle fractures sustained in the athletic setting is dictated by the fracture location and morphology with vertical shear injuries of the medial malleolus commonly requiring surgical plate stabilization. Appropriate knowledge of risk factors and optimal management of these injuries is imperative, given that delayed union or nonunion may result in debilitating consequences for young athletes with extensive time away from sports participation.

The authors are with the Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

Miller (timothy.miller@osumc.edu) is corresponding author.
  • Collapse
  • Expand

International Journal of Athletic Therapy and Training

Cover International Journal of Athletic Therapy and Training
  • 1.

    Court-Brown CM, Wood AM, Aitken S. The epidemiology of acute sports-related fractures in adults. Injury. 2008;39(12):1365–1372. PubMed ID: 18514656 doi:10.1016/j.injury.2008.02.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Brodie IA, Denham RA. The treatment of unstable ankle fractures. J Bone Joint Surg Br. 1974;56(2):256–262. PubMed ID: 4212457 doi:10.1302/0301-620X.56B2.256

  • 3.

    Muller ME, Koch P, Nazarian S, Schatzker J. Tibia/Fibula. In: Muller ME, Koch P, Nazarian S, Schatzker J, eds. The Comprehensive Classification of Fractures of Long Bones. Berlin, Germany: Springer; 1990:148–191.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Herscovici D Jr, Scaduto JM, Infante A. Conservative treatment of isolated fractures of the medial malleolus. J Bone Joint Surg Br. 2007;89(1):89–93. PubMed ID: 17259423 doi:10.1302/0301-620X.89B1.18349

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Chandler RW. Management of complex ankle fractures in athletes. Clin Sports Med. 1988;7(1):127–141. PubMed ID: 3136934

  • 6.

    Ebraheim NA, Ludwig T, Weston JT, Carroll T, Liu J. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry. Foot Ankle Int. 2014;35(5):471–477. PubMed ID: 24525543 doi:10.1177/1071100714524553

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Bauer M, Bergstrom B, Hemborg A, Sandegard J. Malleolar fractures: nonoperative versus operative treatment. A controlled study. Clin Orthop Relat Res. 1985;199(199):17–27.

    • Search Google Scholar
    • Export Citation
  • 8.

    Phillips WA, Schwartz HS, Keller CS, et al. A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg Am. 1985;67(1):67–78. PubMed ID: 3881447 doi:10.2106/00004623-198567010-00010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Davis AW, Alexander IJ. Problematic fractures and dislocations in the foot and ankle of athletes. Clin Sports Med. 1990;9(1):163–181. PubMed ID: 1967555

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    van den Berg C, Haak T, Weil NL, Hoogendoorn JM. Functional bracing treatment for stable type B ankle fractures. Injury. 2018;49(8):1607–1611. PubMed ID: 29903578 doi:10.1016/j.injury.2018.06.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Lempainen L, Liimatainen E, Heikkila J, et al. Medial malleolar stress fracture in athletes: diagnosis and operative treatment. Scand J Surg. 2012;101(4):261–264. PubMed ID: 23238501 doi:10.1177/145749691210100407

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Weinraub GM, Levine P, Shi E, Flowers A. Comparison of medial malleolar fracture healing at 8 weeks after open reduction internal fixation versus percutaneous fixation: a retrospective cohort study. J Foot Ankle Surg. 2017;56(2):277–281. PubMed ID: 28087232 doi:10.1053/j.jfas.2016.11.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Blake S, Yakubek G, Shaer J. Use of a locked fibular plate for fixation of a vertical shear medial malleolus fracture: a case report. J Foot Ankle Surg. 2015;54(6):1202–1205. PubMed ID: 26253474 doi:10.1053/j.jfas.2015.06.016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Fowler TT, Pugh KJ, Litsky AS, Taylor BC, French BG. Medial malleolar fractures: a biomechanical study of fixation techniques. Orthopedics. 2011;34(8):e349–355. PubMed ID: 21815575

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Mohammed AA, Abbas KA, Mawlood AS. A comparative study in fixation methods of medial malleolus fractures between tension bands wiring and screw fixation. Springerplus. 2016;5:530. PubMed ID: 27186494 doi:10.1186/s40064-016-2155-z

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Toolan BC, Koval KJ, Kummer FJ, Sanders R, Zuckerman JD. Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques. Foot Ankle Int. 1994;15(9):483–489. PubMed ID: 7820240 doi:10.1177/107110079401500905

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Wegner AM, Wolinsky PR, Robbins MA, Garcia TC, Maitra S, Amanatullah DF. Antiglide plating of vertical medial malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation. Clin Biomech (Bristol, Avon). 2016;31:29–32. doi:10.1016/j.clinbiomech.2015.10.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Porter DA, May BD, Berney T. Functional outcome after operative treatment for ankle fractures in young athletes: a retrospective case series. Foot Ankle Int. 2008;29(9):887–894. PubMed ID: 18778666 doi:10.3113/FAI.2008.0887

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Mayer SW, Joyner PW, Almekinders LC, Parekh SG. Stress fractures of the foot and ankle in athletes. Sports Health. 2014;6(6):481–491. PubMed ID: 25364480 doi:10.1177/1941738113486588

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2035 802 50
Full Text Views 185 4 1
PDF Downloads 98 6 1