In a patient with medial malleolus fracture, what is the most appropriate next step in imaging?

• A. Neurovascular consult
• B. Closed reduction + cast
• C. LE XRAY series
• D. ORIF

Answer: (C)

Imaging first to define the injury is essential whenever a suspected malleolar fracture is present. Getting a lower-extremity radiographic series provides the necessary views (ankle views such as AP, mortise, and lateral, and adjacent leg portions if needed) to clearly define the fracture pattern, displacement, and stability, and to look for associated injuries. Neurovascular assessment is important, but it doesn’t substitute for imaging. Treatment decisions—such as whether reduction or casting is appropriate or whether surgical fixation is needed—rely on what the imaging shows, so obtaining the LE X-ray series is the correct next step.