The medial malleolus is the distal medial projection of the tibia forming the medial wall of the ankle mortise. It articulates with the medial talus and provides the attachment site for the deltoid ligament, the strongest ligament of the ankle. Medial malleolus fractures occur in approximately 50 percent of ankle fractures and require fixation when combined with lateral malleolus fractures or when the medial fragment is displaced.
The medial clear space between the medial malleolus and the medial talus on mortise view radiographs should not exceed 4 mm — greater widening indicates deltoid ligament insufficiency or medial malleolus fracture. Medial malleolus fractures at the base (suprasyndesmotic) are fixed with cancellous screws; tip avulsions (infrasyndesmotic) may be treated conservatively if minimally displaced. The posterior tibial tendon, FDL, and tibial nerve run posterior to the medial malleolus through the tarsal tunnel.
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