The Treatment and Outcomes of Medial Malleolar Stress Fractures: A Systematic Review of the Literature

CONTEXT: The medial malleolus is considered a high-risk stress fracture and can be debilitating to the highly active or athletic populations. A range of treatment methods have been described with varying outcomes. Currently, there is no gold standard treatment option with optimal results described. OBJECTIVE: A systematic search of the literature to determine treatment options and outcomes in medial malleolus stress fractures. DATA SOURCES: OVID/Medline, EMBASE, and the Cochrane Library from 1950 to September 2013. STUDY SELECTION: Included studies mentioned treatment and outcomes of medial malleolus stress fractures. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: The searches used combinations of the terms stress fracture, medial malleolus, management, and treatment. Two authors independently reviewed the selected articles and created individual tables, which were later compiled into a master table for final analysis. RESULTS: Six retrospective case series were identified (n = 31 patients). Eighty percent (25/31) of patients were men, with an average age of 24.5 years. Ninety percent (28/31) of patients were at least involved in recreational athletics. All patients were able to return to sport. Complications were seen in both groups ranging from minor stiffness to nonunion requiring open reduction internal fixation. CONCLUSION: Nonoperative and operative interventions have proven to be successful with regard to healing and return to play for medial malleolar stress fractures in the recreational and competitive athlete. However, early operative intervention can possibly create a higher likelihood of early healing, decrease in symptoms, and return to play.