Plate-Based Operative Management of Medial Malleolar Stress Fractures in High-Level Basketball Players: A Short Report.

Abstract

Background: Medial malleolar stress fractures (MMSFs) are uncommon but potentially high-risk injuries in athletes. In basketball players, repetitive jumping, landing, and cutting may expose the characteristic vertical fracture pattern to substantial shear, yet sport-specific operative data remain limited. This study reports the outcomes of plate-based fixation for MMSFs in high-level basketball players.

Methods: A retrospective case series was performed of 10 high-level basketball players treated surgically for MMSF between 2007 and 2025. All patients underwent radiography, magnetic resonance imaging, and computed tomography (CT). Operative treatment consisted of shear resisting plate-based fixation (one-third tubular anti-glide or hook plate) with fracture-perpendicular screws, selective bone grafting, biologic augmentation, and treatment of associated anterior impingement when indicated. Primary outcomes were radiographic union, return to play, and need for additional surgery.

Results: All patients were male, with a median age of 20.5 years (range, 18-26). Median height was 205.5 cm (IQR, 198-213), and the median weight was 103.5 kg (IQR, 93-113). Eight players were professional and 2 were collegiate athletes later drafted professionally. CT demonstrated a vertically oriented fracture arising from the anteromedial tibial plafond in all cases. Union was achieved in all players. Nine returned to full team activities by 12 weeks and to competitive play at a median of 4 months (range, 3-4 months). One player sustained a traumatic refracture 8 months after index fixation, required 2 revision procedures, ultimately healed after supplemental anterior plating, and returned to play at 6 months.

Conclusion: Plate-based fixation was associated with reliable union and return to play, although revision surgery was required in 1 of 10 players. Given the consistent vertical fracture morphology and substantial sport-specific loading demands, shear resisting plating may be considered in this population.

Level of evidence: Level IV, case series.