Is splinting the best treatment option for my ankle injury?

Question

Hi doctor,

I am a 48-year-old male. I had an X-ray of my right ankle. The technique used was three view exam. The findings are as follows: Spiral fracture of the distal fibula. This is anatomic in alignment. Cortical avulsion of the medial malleolar process. The cortex of the malleolus at the deltoid ligament attachment has been avulsed. There is a nondisplaced posterior tibial malar fracture. The talus appears to sit somewhat posterior in the ankle joint on the lateral view which could be a rotation. I believe there is an incidental fibrous cortical lesion on the lateral surface of the tibial shaft just above the ankle joint. Note that for thoroughness. A hard half splint was applied in ER and that same splint remains on after a visit with an orthopedic surgeon. I have a follow-up visit in a few days. My concern is, was this the best course of treatment for this injury? I was told that I could bear weight as tolerated but that is nearly impossible due to the amount of discomfort. This damage was caused by a fall. I have attached my X-rays here.

Answer 1

Hi,

Welcome to icliniq.com.

I believe that surgery for plating of the fibula would have been an option I would seriously consider (attachment removed to protect patient identity). You can still consider this option if another check x-ray shows that the talus is displaced when in a dorsiflexed position. Undisplaced fractures are managed non-surgically, but yours is minimally displaced with slight subluxation of the talus. You need to see subluxation of the talus when you take an ankle x-ray with the foot neutral position and not in plantar flexion.