Isolated Posterior Malleolus Fracture with Early Symptom Resolution: A Case Report.

Introduction: Isolated posterior malleolus fractures are uncommon and may present with subtle radiographic findings and rapid clinical improvement, creating potential for underrecognition or premature de-escalation of care. To our knowledge, reports specifically highlighting early symptom resolution as a management pitfall in isolated posterior malleolus fractures are limited in the literature. Case Report: A 29-year-old female sustained a left ankle injury following a fall while recreational ice skating. Initial radiographs demonstrated a non-displaced posterior malleolus fracture with an intact ankle mortise and no medial or lateral malleolar involvement. One week after injury, the patient reported complete resolution of pain despite persistent swelling and radiographic evidence of fracture. Serial imaging demonstrated maintained alignment without interval displacement. The patient was managed conservatively with immobilization, activity modification, and follow-up monitoring. At 2 months post-injury, repeat radiographs demonstrated bony union with preserved ankle congruency. Conclusion: Isolated posterior malleolus fractures may demonstrate rapid symptom resolution despite persistent radiographic injury. Clinical improvement alone should not guide de-escalation of treatment. Careful radiographic evaluation and continued immobilization are essential to ensure appropriate healing and prevent premature return to activity.