The ankle x-ray shows a minimally displaced fracture through the medial malleolus. On the lateral view, the fractured fragment is seen minimally displaced anteriorly. There is soft tissue swelling over the malleoli.
Isolated medial malleolar fracture as in this case or isolated widening of the medial ankle joint space should alert one to the possibility of a fracture high up in the fibula (also called Maisonneuve fracture).
This patient went on to have a left leg x-ray which showed a minimally displaced oblique fracture of the proximal fibula. He underwent internal fixation.