Isolated Lateral Malleolus Fracture
Fractures of the lateral malleolus in the skeletally immature patient are relatively common. Although in many cases these are associated with fractures of the distal tibia, the distal fibula may be fractured in isolation. In the majority of these, the fracture is non-displaced and diagnosed on the basis of soft tissue swelling and tenderness at the level of the distal fibular physis. Additionally, displaced Salter-Harris types I and II patterns may be seen. These occur most commonly in patients between the ages of 10 and 12 years. The mechanism of injury is typically due to supination-inversion. Treatment of non-displaced fractures may be safely performed either with a short leg walking cast or a brace, depending on surgeon and patient preference. Displaced fractures should be reduced and immobilized in a non-weightbearing cast for 4–6 weeks. While growth arrest and shortening have both been reported in a small number of patients with type I fractures, complications with type II fractures remain rare.