Double Threaded Screw Fixation for Bilateral Stress Fracture of the Medial Malleolus

An 18-year-old college basketball player presented with continued ankle pain. A radiographic examination showed bilateral medial malleolus stress fractures. Considering the prolonged history and refractory nature of this injury, surgery was adopted as a treatment option. At surgery, the fracture site was percutaneously fixed using two cannulated double threaded screws. Surgery for each side was sequentially performed two months apart. Prompt bony healing was attained after surgery, and the patient could return to his previous sports level six months after the first surgery without subsequent recurrence. 1. Introduction Repetitive loading during regular strenuous sports activity may cause stress fractures necessitating interruption of play. Its incidence in athletes has been reported to be around 2.0% [1–3]. The most common location is on the posteromedial-concave side of the tibial shaft [1], while stress fractures of medial malleolus are extremely rare. Shelbourne described 6 patients with stress fracture of this type in 1988 [4]. All of the patients were involved in running or jumping activities such as basketball, long distance running, and football. The typical clinical sequence of this stress fracture is gradual onset of pain and discomfort over the medial malleolus followed by prolonged symptoms. The radiological appearance is characterized by a vertically oriented fissure originating from the tibial plafond and medial malleolus junction or an obliquely arched radiolucent line through the medial malleolus; however, routine radiographs often appear normal at initial presentation. Therefore, for patients with clinical features suggestive of this stress fracture, bone scan or MRI may be considered for early diagnosis [5–7]. Since this fracture is mostly encountered among high level athletes, prompt diagnosis with aggressive intervention is critical to enable early return to original sports activity. The basic treatment option for stress fractures, in general, is conservative measure consisting of cessation of running and jumping activities; however, stress fracture of the medial malleolus is often complicated with delayed healing or recurrence necessitating surgery. In this case report, we present a case of a college basketball player, who sustained bilateral medial malleolus stress fractures and sequentially underwent surgical treatment using double threaded screws. He was able to successfully go back to the original sports activity following the bilateral surgeries. In previous literatures, bilateral medial malleolus stress fracture has been