A 40-year-old woman presents to urgent care for evaluation of ankle pain following a car accident. She was a restrained driver who lost control of her vehicle while driving on wet roads. Her vehicle hit a telephone pole head on. There was no air bag deployment. Initially, she thought she was fine and declined EMS transport to a local hospital. But when she experienced severe pain bearing weight on her right foot, she opted to have it evaluated.
She denies any other complaints. Her medical history is otherwise unremarkable, and vital signs are normal. Physical examination of her right ankle demonstrates general soft-tissue swelling but no obvious deformity. She has moderate tenderness on both the medial and lateral aspects of her ankle. She has limited dorsiflexion and plantar flexion secondary to pain. Good distal pulses are palpable, and good capillary refill is noted in all of the toes.
A radiograph of the ankle is shown. What is your impression?
The radiograph shows an acute fracture of the medial malleolus. It is minimally displaced. The mortise joint appears intact. The patient was placed in a short leg splint for immobilization, and prompt orthopedic follow-up was arranged.