Acute on chronic stress fracture after a medial malleolar osteotomy following osteochondral lesion of the talus treatment.

A patient in his 40s presented at the outpatient clinic with sudden pain and swelling over his medial malleolus, 16 weeks after he had undergone osteoperiosteal autografting with a medial malleolar osteotomy for his tertiary osteochondral lesion of the talus. Postoperatively, the patient was treated using the regular evidence-based rehabilitation protocol of 5 weeks of non-weight-bearing and 5 weeks of partial weight-bearing. However, after the confirmed radiological union the patient experienced an acute on chronic stress fracture through the osteotomy line. The fracture was treated with immobilisation and all problems disappeared 16 weeks after the initial presentation of the fracture. The present case highlights the importance of a gradual increase in post-operative activities, even when radiological union has been observed.