What is probable mechanism of such medial malleolar # and the line of management of this 78M.
Mal-alignment with abnormal transfer of vector forces to the ankle could result in the stress fracture of the medial malleolus. Malleolar screw fixation should be secondary to correcting the varus deformity in the knee as well as OA by TKR.
I agree. But the exact mechanism of such a stress is still perplexing me.
In my opinion the occurence of this stress fracture is related to the physical activity of the patient. In spite of the knee defromity there are very active persons with high pain threshhold who do not stop walking, running, etc. I may imagine that this patient belongs to this group.
But this patient was not at all physically active. Hence, abnormal stress seems to be only explainable reason for this stress #
I have seen several of these on professional football players, of course with not an OA developed yet, but always with a significant varus trend of knee/tibia , and the vertical line of the medial malleolus fracture.
I agree that stress #s are common in young athletes, rather than in elderly with OA. severe and long lasting knee deformity seems to be an obvious responsible factor in its causation.
Please refer to our publication on it: http://www.jocr.co.in/wp/2018/01/10/2250-0685-1014-fulltext/
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