Yoshimoto Kensei, Noguchi Masahiko, Maruki Hideyuki, Ishibashi Mina, Okazaki Ken
Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-0054, Japan; Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan.
Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-0054, Japan; Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan; Orthopedic Foot and Ankle Center, Daisan, Kitashinagawa Hospital, 3-3-7 Kitashinagawa, Shinagawa-ku, Tokyo 140-0001, Japan.
Int J Surg Case Rep. 2021 Jan;78:235-240. doi: 10.1016/j.ijscr.2020.12.043. Epub 2020 Dec 25.
Medial malleolar stress fractures are relatively uncommon. This report describes the successful treatment of nonunion of a medial malleolar stress fracture due to chronic lateral ankle instability.
A 13-year-old middle school student who belonged to a football club presented to our clinic with chronic medial left ankle pain lasting over a year. He had sprained his left ankle several times 6 years earlier. A plain anteroposterior ankle radiograph showed a vertical fracture line in the medial malleolus involving the epiphyseal plate, and computed tomography demonstrated the vertical fracture seen on the plain radiographs and bone sclerosis at the fracture site. We performed internal fixation for nonunion of the medial malleolar stress fracture with arthroscopic modified Broström for lateral ankle instability. Two years after surgery, the Self-Administered Foot Evaluation Questionnaire improved in all parameters, and both the anterior drawer and varus stress tests were negative.
Early diagnosis of medial malleolar stress fracture is important for a rapid return to sports. Magnetic resonance imaging is helpful for early diagnosis. Because lateral ankle instability can cause medial malleolar stress fracture, arthroscopic modified Broström procedure is meaningful for medial malleolar stress fracture with lateral ankle instability.
Internal fixation and the arthroscopic modified Broström procedure could achieve good clinical outcomes for medial malleolar stress fractures with lateral ankle instability.
内踝应力性骨折相对少见。本报告描述了因慢性外侧踝关节不稳导致的内踝应力性骨折不愈合的成功治疗案例。
一名13岁的中学生，是足球俱乐部成员，因左踝内侧慢性疼痛超过一年前来我院就诊。他6年前曾多次扭伤左脚踝。踝关节正位X线片显示内踝有一条垂直骨折线累及骨骺板，计算机断层扫描显示了X线平片上所见的垂直骨折以及骨折部位的骨质硬化。我们对内踝应力性骨折不愈合进行了内固定，并对外侧踝关节不稳采用关节镜改良布罗斯特伦手术。术后两年，自我管理足部评估问卷的所有参数均有所改善，前抽屉试验和内翻应力试验均为阴性。
内踝应力性骨折的早期诊断对于快速恢复运动很重要。磁共振成像有助于早期诊断。由于外侧踝关节不稳可导致内踝应力性骨折，关节镜改良布罗斯特伦手术对于伴有外侧踝关节不稳的内踝应力性骨折具有重要意义。
内固定和关节镜改良布罗斯特伦手术对于伴有外侧踝关节不稳的内踝应力性骨折可取得良好的临床效果。
