Scroll through the images. Fractures of the lateral malleolus are the most common type of ankle fracture. Link, Google Scholar; 18 Capps GW, Hayes CW. Semin Musculoskelet Radiol. Imaging of the proximal fibula should also be . Final diagnosis is a Weber C fracture or according to Lauge Hansen: Pronation Exorotation injury stage 4. This can be a stage 2 of a Weber C fracture. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Morgan M, Hacking C, Hacking C, et al. By the way.there are two fractures. Usually, you will need to stay off the ankle for several weeks after surgery. There is a Tillaux fracture due to avulsion of the anterolateral part of the distal tibia by the anterior syndesmosis. The fracture through the growth plate is usually obscure and difficult to differentiate from normal variations of the growth plate. The patient presented with lateral ankle pain associated with tenderness at the tip of the lateral malleolus. Mosby. This rare injury cannot be classified by commonly used Salter Harris classification for epiphyseal injury. . When we study the radiographs of a patient with an ankle injury, we have to study the region of the posterior malleolus very carefully. Study these images carefully and remember the stages of an exorotation injury. Simulated avulsion injuries related to these ligaments were created, and the visibility of these structures was assessed. There are two basic types of ankle fractures: 1) High Energy Axial Injuries: Pilon 2) Rotational Injuries: - Malleolar - either medial or lateral - Bimalleolar - both medial and lateral - Trimalleolar - includes posterior malleolus The direction of the force determines the fracture pattern - external rotation, abduction, adduction. There is a subtle widening of the lateral part of the growth plate of the right ankle. . This is the most common type of growth plate fracture, and tends to occur in older children. An oblique or vertically oriented fracture indicates 'push-off'. lateral malleolus fracture with talar shift (static or stress view) technique. Fractures Avulsion fractures are breaks or splits in the bone. On the AP-view the linear lucency is the clue to a tertius fracture (red arrow). When the fracture happens, the tendon or ligament pulls away, and a small piece of. The fracture may sometimes be difficult to identify on radiographs and CT may be necessary to identify the fracture line. It is a transverse fracture through the cartilage of the growth plate or physis. Surgical Treatment Surgical repair is necessary when a lateral malleolus fracture is displaced. ADVERTISEMENT: Supporters see fewer/no ads. If this is not visible in the distal fibula then further X-rays of the proximal fibula should be performed. The repair is typically done with a plate and screws. They are commonly injured in the case of ankle sprains. On the left image the lateral malleolus is pushed off by exorotation of the talus. An ankle avulsion fracture is a bone chip caused by a ligament or tendon that tears away a part of the bone. Unable to process the form. Soft tissue swelling both medial and lateral (red arrows). 30. Example 3 Soft tissue swelling over the lateral malleolus. In this case there is a Weber B fracture with avulsion of the medial malleolus. Morrison WB, Sanders TG. Recently resuscitative endovascular balloon occlusion (REBOA) has been added to the armamentarium for life-threatening pelvic fracture bleeding57,58 (Fig. You can use Radiopaedia cases in a variety of ways to help you learn and teach. A fracture should be suspected when there is soft tissue swelling inferior to the lateral malleolus. It is important to see your doctor as soon as the accident takes place to prevent more damage. Skeletal anatomy of the ankle Ligaments connect bone to bone to provide stability of the joints. Before you read this article, you need to understand the classification of ankle fractures and exorotation injuries that were highlighted in Ankle - Fractures 1 and 2. Oblique fracture. It is a high Weber C fracture. The ATFL attaches to the distal end of the fibula and the lateral surface of the talus bone, having its center approximately 10 mm above the apex of the lateral malleolus. This is also a Salter-Harris type III fracture. Since they are generally the result of external rotation and abduction, they are almost always seen in . The injury can continue to the following: In all these subsequent stages, purely ligamentous injury will not be visible on the radiographs of the ankle. ( avulsion fracture) Transverse fracture (like our case) Vertical fracture. They may also occur due to an awkward landing from a jump (particularly on uneven surfaces), due to a fall or following a direct blow to the outer ankle. Fractures of the ankle, combined experimental-surgical and experimental-roentgenologic investigationsby N. Lauge-Hansen (1948). Lateral X-ray Frontal Anteromedial soft tissue swelling. Bone edema around the lateral aspect of the calcaneocuboid joint, without associated lesions of the dorsal . avulsion tip fractures of medial or lateral malleolus . Thin bony fragments adjacent to the lateral aspect of tip of the lateral malleolus and cortical irregularity at the lateral talus, likely representing avulsion fractures. The lateral side is under extreme tension with stretch on the ligaments which results in an avulsion fracture. More commonly there is a small avulsion fragment. New radiographic projections for avulsion fractures of the lateral malleolus. Incidental note of os subfibulare and os trigonum. Fractures of the proximal fifth metatarsal, in contrast, are usually transverse to the metatarsal base, although oblique fractures may occur (see Chap. By Jonathan Cluett, M.D., About.com Guide, Appendicitis - Pitfalls in US and CT diagnosis, Acute Abdomen in Gynaecology - Ultrasound, Transvaginal Ultrasound for Non-Gynaecological Conditions, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System. Easily missed injuries around the knee. The Salter-Harris classification describes fractures that involve the epiphyseal plate or growth plate. Do you have an idea what kind of injury this is? In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. Almost all fractures of the posterior malleolus are part of a rotational injury resulting in a Weber B or Weber C fracture. Study the images and then continue reading. modalities. You can enlarge the images by clicking on them. Medial soft tissue swelling and a tertius fracture are both indications of a Weber C or Pronation Exorotation injury. Any medial painful swelling or hematoma They can happen when you take an awkward or uneven step that causes you to twist or roll your ankle. Tillaux fracture. CAM boot. It is amazing, that such a large tertius fragment is so difficult to see on the radiographs. You may have to enlarge the image, turn down the room lights, and adjust the contrast and brightness on your monitor. 1. Here more examples of the bright line that indicates a tertius fracture. Notice also that the medial epiphysis is already closed, while the lateral portion is still open(blue arrows). Soft tissue swelling over the lateral malleolus. RadioGraphics 1994; 14:1191-1210. The fracture occurs when the medial epiphysis has fused and the lateral part becomes avulsed at the attachment of the anterior tibiofibular ligament (or syndesmosis). In most cases, people return to normal daily activities within 3 to 4 months. The type of treatment depends on the fracture grade 6: If symptomatic non-union occurs, debridement may be necessary. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. The ankle is the most frequently injured joint. Abstract. 3, 2009 315 Acta Clin Croat 2010; 49:315-329 Case Report UNRECOGNIZED FRACTURE OF THE POSTEROMEDIAL PROCESS OF THE TALUS - A CASE REPORT AND REVIEW There was no evidence of joint instability. Check for errors and try again. In 1840 Maisonneuve described a frature of the proximal shaft of the fibula, which was caused by exorotation force applied to the ankle. These Salter-Harris fractures can be easily missed. So we have to look for higher stages. An avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. Problem Solving in Musculoskeletal Imaging. Acta Clin Croat, Vol. There are five types of medial malleolus fractures: Chip fracture. Also notice the soft tissue swelling on the medial side indicating rupture of the medial collateral ligaments (arrow). Radiology. The CT-images show a epiphysiolysis fracture Salter Harris type 3. Stage 1: stable ankle fracture Stage 1 Here a typical avulsion or pull-off fracture of the lateral malleolus. for medial malleolus fractures (Fleiss' = 0.59, 95% CI 0.54-0.65). Conclusion In trimalleolar ankle fractures, the AO/OTA classication is a reliable system to characterize the type of fracture, There are three situations in which we should suspect a high Weber C or Maisonneuve fracture: Isolated fracture of the medial malleolus A small avulsion fracture is noted between the dome of the talus and the medial malleolus. On the lateral projection, an os trigonum can be appreciated. First study the radiographs and then continue with the CT. Isolated lateral malleolus fractures are the most common fracture involving the ankle. The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. Another Tillaux in a patient with a strange combination of findings. PE stage 4. posterior malleolar fracture with < 25% joint involvement or < 2mm step-off. These injuries also tend to affect older children in whom the growth plate is partially closed. Type V growth plate injuries occur with the growth plate is crushed. The fracture occurs when the foot is dorsiflexed and inverted, as can happen with snowboarding (hence the term "snowboarder fracture")1. Check for errors and try again. Type III is a fracture through the growth plate and epiphysis sparing the metaphysis. This patient had a twisted ankle and the only abnormality is seen on the lateral view. Isolated nondisplaced lateral malleolar fractures have a low risk of complications and have good clinical results regardless of treatment.8,9 Small nondisplaced avulsion fractures of the tip of the lateral malleolus ( Figure 13-4) are best treated with early mobilization similar to treatment of an ankle sprain. A transverse or horizontal fracture is the result of a 'pull-off'. Check for errors and try again. The technician made the standard AP-, Mortise- and lateral view and showed them to the radiologist, who was a little bit puzzled. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Radiographics. In this case no fracture is seen, but only soft tissue swelling on the medial side. Anterior distal tibial spurring. This should make you consider a tertius fracture. A common spot for avulsion fractures is at the lateral malleolus or outside ankle bone. Yellow arrow indicates os subfibulare. 4. Alignment has been maintained. 16). ISBN:B0040SYP2C. The AO Surgery Reference is a huge online repository of surgical knowledge, consisting of more than 7000 pages. It may be an isolated fracture or occur as a component of more complex ankle fractures. There is only a small metaphyseal fragment, which is usually the case (red arrow). {"url":"/signup-modal-props.json?lang=us\u0026email="}, Knipe H, Medial malleolus avulsion fracture. A lateral malleolus fracture is a type of ankle fracture that occurs when the fibula fractures just above the ankle joint. These types of fractures may permanently injure the growth plate, requiring later treatment to restore alignment of the limb. As many as 40-50% of fractures are missed on radiographs due to overlapping osseous structures 2. Diagnosis of avulsion fractures of the distal fibula after lateral ankle sprain in children : a diagnostic accuracy study comparing ultrasonography with radiography. Mosby. A Weber B fracture is easily detected because of the characteristic oblique fracture. Standard projections were found to adequately depict avulsion fractures related to the TC and CF . Clinical examination findings are important but less reliable. The severity an ankle avulsion fracture can result in anything from a minor issue to something that requires surgery. An avulsion fracture, also known as a sprain fracture, is a detachment of bone fragment that occurs when a ligament, tendon or joint capsule pulls away from its point of attachment. 60 (6), 1953 . 6. Jibri Z, Mukherjee K, Kamath S et-al. Stress placed on the bone by a tendon or ligament causes the fracture. And finally we tend not to look carefully at the epiphysis. This case demonstrates that there can be an unstable ankle injury that needs surgery even when the radiographs of the ankle do not show a fracture. [3] ISBN:0323072437. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Can be difficult to identify on initial presentation (diagnosis is usually made when growth arrest is seen on follow-up radiographs) 2b: >2 mm displacement of fracture fragments; grade 3: cortical avulsion fracture; MRI. Continue with the images of the lower leg. Ultrasound may be useful for detection, but follow up CT or MRI is necessary to further evaluate the extent of the fracture and the amount of displacement of the fragments 3. Weber C fractures can be further subclassified as 6. The diagnosis is made by x-raying the ankle. short-leg cast. As the bone breaks, the part of the bone that is attached to the tendon or ligament pulls away from the rest of the bone. 1995;197(2):439-42. Clinical examination findings are important but less reliable. Radiology. Point your toes down as far as they go, then use the other foot on top to apply some pressure to create a stretch on the top of your foot. The lateral malleolus is part of the fibula, one of two bones of the lower leg, which carries about about 10% of your weight. In any patient with an ankle injury you should always ask yourself the questioncan I exclude a high Weber C fracture or do I need additional imaging. 5. 1996;47: 1170-5. unfit for surgery. Avulsion fractures are breaks or splits in the bone. Notice that there is also a Tillaux fracture. The tertius fracture is stage 3 in Weber B and stage 4 in Weber C (figure). In many cases there is only a small gap between the fracture parts and detection depends on optimal radiography and a high level of suspicion. Although a fracture of the medial malleolus can be a serious injury, the outlook for recovery is good, and complications are . Maybe the fracture is seen on the AP-view as indicated by the red arrows, but this is questionable. Note saucerlike defect in inferior aspect of calcaneus from bone lysis ( curved arrow ). ADVERTISEMENT: Supporters see fewer/no ads. This may be hard to see. C1: diaphyseal fracture of the fibula, simple; C2: diaphyseal fracture of the fibula, complex; C3: proximal fracture of the fibula. Stages of exorotation injuries of the ankle. Do you now see the tertius fracture on the axial CT-image? On the left images of a patient with a hematoma on the medial side. Notice that there is also an avulsion at the tibial insertion of the anterior syndesmosis, i.e. Unable to process the form. Type V growth plate fractures carry the most concerning prognosis as bone alignment and length can be affected. Knowing that this can be the only clue to a high Weber C, additional radiographs were taken. The avulsion fragment is quite large. In such a case, you have to rule out a Maisonneuve fracture, which is a high Weber C fracture. At surgery the ankle was found to be unstable and syndesmosis screws were inserted. It can be seen as a widening of the lateral masses and loss of congruity with the axis beneath. ATFL injuries can present as an isolated tear or accompanied with avulsions of the lateral malleolus. short-leg AO splint. avulsion fracture at the base of the 5th metatarsal: potts fracture: avulsion fracture of the medial malleolus with loss of the ankle mortise: osteomalacia (Rickets) A, Lateral radiograph shows fracture ( straight arrow) through enthesophyte emanating from medial plantar process. However, a. Whenever you see such a fracture, you have to look for higher stages of this exorotation injury. View larger version (251K) Fig. This is called a pull off type of fracture in contrast to a push off type, which is seen as an oblique or vertical fracture. Fibular avulsion fractures most commonly occur from an inversion of the ankle that causes the ankle ligaments to pull a small piece of bone off of the end of the fibula. This juvenile Tillaux is especially seen in young athletes. Yellow arrow indicates os subfibulare. Radiology 1986; 159:467-469. Always look for higher stages of an exorotation injury. Unable to process the form. This occurs as tendons can bear more load than the bone. Continue with the CT. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-89034. We have to assume that there is an epiphysiolysis of this lateral portion. FRACTURE OF THE LATERAL PROCESS OF THE TALUS. Since there is no fibula fracture seen on the x-rays of the ankle, there must be a high fibular fracture. This woman had a distortion of the ankle and had pain on both medial and lateral side. So even in a Weber C stage 4 sometimes only a fracture of the medial malleolus will be visible. This fracture is named triplane because it occurs in the coronal, sagittal and axial plane. 2004;24 (4): 1009-27. Lateral Malleolus Fractures are generally stable fractures but traumatic events such as a fall or trip can lead to an unstable fracture. Blue arrow indicates avulsion fracture. The most effective methods for assessing tibiotalar instability include stress and weight-bearing radiographs. Sonographic diagnosis of talar lateral process fracture. It can be caused by traumatic traction (repetitive long-term or a single high impact traumatic traction) of the ligament or tendon. 2013;17 (04): 416-28. Most type I growth plate injuries are treated with a cast. Likewise in some cases malalignment can result in a linear density. This fracture is named triplane because it occurs in the coronal, sagittal and axial plane. Study the images and then scroll to the next images. The alignment is so perfect, that you do not see the fracture on the radiographs. Less frequently it leads to an avulsion of the anterolateral tibial epiphysis. The injury produces pain, tenderness, and swelling of the ankle making weight-bearing difficult or impossible. Failure to detect the fracture may lead to non-union,ankle instability, and accelerated osteoarthritis. External rotation injury of the ankle is the most common ankle injury and can lead to a Weber B or Weber C fracture. J Bone Joint Surg Br. There is also a very subtle fracture through the epiphysis. Lucent line on Mortise view (black arrow) and lateral view. So this is the fracture of the metaphysis in the coronal plane. As in most ankle fractures the mechanism is external rotation. Frequently missed findings in acute ankle injury. It is the most common type of ankle fracture and may happen. The fracture through the growth plate is only seen on CT. Check for errors and try again. Introduction:Traumatic rupture of posterior tibialis tendon in association with medial malleolus fracture is extremely rare.Case Presentation:We demonstrate our experience in the management of a co. In the illustration we see the fractures and ligamentous injury on the left and the resulting x-rays on the right. Comminuted fracture. It results from subtle malalignment of the fracture fragment. Diagnostic guidelines for suspected ankle fracture are from the American College of Radiology. Hold both stretches for up to 30 seconds and repeat 3 times. The bright side is that the majority of lateral malleolus fractures are considered steady ankle fractures and can be treated without surgery. Stretching and strengthening exercises supervised by a doctor or physical therapist can help improve ankle function and mobility during the healing process. The small bony chips lateral to the tip of the lateral malleolus represent an avulsion fracture while the well-corticated bony fragment adjacent to the medial aspect of the lateral malleolus tip could be mistaken for fracture if this was not the typical appearance and location for an accessory ossicle - the os subfibulare. Crush injury to the physis. Mildly displaced avulsion fracture from the tip of the medial malleolus in keeping with a deltoid ligament injury. A common spot for avulsion fractures is at the lateral malleolus or outside ankle bone . The patient was treated with immobilization for 4 weeks and anti-inflammatory agents. Study the images and then scroll to the next images. Alignment has been maintained. Feel a stretch in the back of your calf. This case illustrates the importance of medial soft tissue swelling aswell as the finding of a tertius fracture. Fractures of the lateral margin of the distal tibia are usually avulsion fractures of the anterior or posterior tibial tubercle, caused when the anterior or posterior inferior tibiofibular ligament fails to tear during an injury. Salter-Harris I distal fibula fractures can be diagnosed if there is tenderness directly on the lateral malleolus (rather than the ligaments) and many recommend treating as a fracture even if no radiographic fracture is noted. This combination of findings implicate that the ankle is unstable. A lateral malleolus fracture commonly occurs in association with a rolled ankle particularly with significant weight bearing forces. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Lateral talar process fracturesor snowboarder fractures are talusfractures that can mimic a lateral ankle sprain. Almost always the avulsion is seen as a horizontal fracture. It is important to find these fractures, since a tertius fracture can be the only clue to an unstable ankle injury. Weber-A stage I Stage 1 Here we have images of an extremely difficult case. You can use Radiopaedia cases in a variety of ways to help you learn and teach. The most effective methods for assessing tibiotalar instability include stress and weight-bearing radiographs. This case demonstrates why a knowledge of common anatomical variants is essential. Soft tissue swelling over the lateral malleolus. The images show an obvious Weber B fracture. Thin bony fragments adjacent to the lateral aspect of tip of the lateral malleolus and cortical irregularity at the lateral talus, likely representing avulsion fractures. The lateral malleolus of the flexed leg lies across the other leg superior to the patella. It is actually a Salter-Harris type IV. Link, Google Scholar; 19 Goldman AB, Pavlov H, Rubenstein D. In some cases the tertius fractures are easily seen on the x-rays, but frequently they can be difficult to detect. A proximal fibular injury (i.e. These fractures are also named triplane fractures. At first this looks like a Weber B fracture with an oblique fracture in the fibula as seen on the lateral view (black arrows). What is going on here? It is the most common of the ankle joints to fracture. Unable to process the form. Notice however that this fracture line stops at the level of the epiphyseal plate. It is seen exclusively in young adolescents in the period, when the medial tibial epiphysis is closed, while the lateral portion is still open leaving it vulnerable to injury. The pain was worse with weight-bearing. Stage 1 is rupture of the medial collateral ligaments and stage 3 is a fibula fracture above the level of the syndesmosis. On the AP-view there is a lucency within the epiphysis, which is the epiphyseal fracture in the sagittal plane. The most common is type II, which accounts for 75%. were recorded: medial malleolus, lateral malleolus/distal fib-ula, posterior malleolus, talus, calcaneus, navicular, cuboid, . In many cases there is only minimal or no displacement. 1 These breaks are the most common type of ankle fracture. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Knipe H, Lateral malleolus avulsion fracture with os subfibulare. Often type II growth plate fractures must be repositioned under anesthesia, but healing is usually quick and complications are uncommon. In children, a fibula fracture usually requires a short leg cast and six weeks of non-weight bearing. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Knipe H, Lateral malleolus avulsion fracture with os subfibulare. In some cases a fracture of the posterior malleolus is barely or not visible on the radiographs and can only be seen on CT. This spot was marked and a fracture was found. contusion and small avulsion fracture of the anterior process of the cal- . Call our Ankle Fracture Line at 833.294.9759 Anatomy of the ankle joint The ankle joint is composed of the tibia, fibula and talus bones. The diagnosis of apophyseal separation should be made with caution, since the normal ossific portion of the apophysis may be quite lateral in the cartilaginous mass (Fig. a fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint; usually associated with an injury to the medial side Increased risk of physeal arrest. It occurs before the distal tibial epiphysis has completely fused. Management decisions are based on the interpretation of the AP and lateral X-rays. First study the images and then continue reading. The talus (or "ankle bone") connects your leg to your foot. These fractures are easily overlooked because the patients rarely complain of pain in the region of the proximal fibula, since the ankle is most painful. An isolated fracture of the medial malleolus, or widening of the ankle joint with no visible fracture seen on ankle X-ray, should raise the suspicion of an associated fracture of the fibula. J Bone Joint Surg Am. In the setting of an isolated lateral malleolus fracture, identifying injury to this ligament and associated ankle instability influences management. There is an avulsion of the lateral malleolus, a Tillaux and a medial malleolar fracture. fluid-sensitive sequences: if an acute injury, there may be bone marrow edema in the lateral process; T1: hypointense fracture line through the lateral process (fracture line and/or cortical step off may be better seen on CT) Ultrasound On the lateral projection, an os trigonum can be appreciated. Proper positioning is essential after a type II growth plate fracture. The lateral malleolus sits on the outside of the ankle joint and absorbs approximately 10% of your weight in standing. This tertius fracture can also be seen on the lateral view, but in many cases we need all the information of both the lateral and AP-view to diagnose a tertius fracture. . The small bony chips lateral to the tip of the lateral malleolus represent an avulsion fracture while the well-corticated bony fragment adjacent to the medial aspect of the lateral malleolus tip could be mistaken for fracture if this was not the typical appearance and location for an accessory ossicle - the os subfibulare. These injuries generally occur when the ankle is either twisted or rolled, frequently with an awkward or unequal action. This case demonstrates why a knowledge of common anatomical variants is essential. Lateral malleolus fractures are common in running and . It is seen exclusively in young adolescents in the period, when the medial tibial epiphysis is closed, while the lateral portion is still open leaving it vulnerable to injury. According to Lauge Hansen we can conclude that this patient first had a rupture of the medial collateral ligaments (stage 1), followed by a rupture of the anterior syndesmosis (stage 2) and a high fibula fracture (stage 3) and finally an avulsion of the posterior malleolus, i.e. Lateral X-ray Frontal Thin bony fragments adjacent to the lateral aspect of tip of the lateral malleolus and cortical irregularity at the lateral talus, likely representing avulsion fractures. ADVERTISEMENT: Supporters see fewer/no ads. At that age it is a fracture through the growth plate and is then called a juvenile Tillaux. Several ankle ligaments ensure the static and dynamic stability of the ankle joint, but they are prone to injury due to acute trauma as well as repetitive ankle sprains. This small fragment is best seen on the AP view just inside the medial malleolus. In rare case you may find a vertical fracture of the medial malleolus in combination with a collateral band rupture on the lateral side. Here another example. ADVERTISEMENT: Supporters see fewer/no ads. Lee P, Hunter TB, Taljanovic M. Musculoskeletal colloquialisms: how did we come up with these names?. 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