Symptomatic Os Subtibiale Following Injury: A Case Report of Failed Conservative Treatment, Leading to Differential Diagnosis Made Intraoperatively

Os subtibiale is a rare accessory bone found adjacent to the distal tibia and is mostly asymptomatic. Differentiating it from a medial malleolar fracture is challenging. Most cases of acute ankle trauma that presents with an Os subtibiale are initially diagnosed as fractures by treating physicians at emergency centers. It is therefore critical for an orthopedic surgeon who gets referral for such cases to consider complete history of such patients to understand the cause of their symptoms. The goal is to avoid unnecessary surgical treatment and to realize that a symptomatic Os subtibiale can be successfully managed by conservative means. Nonetheless, certain cases may require surgical treatment if conservative treatment options fail. This is a case report of a patient that was diagnosed as a case of symptomatic Os subtibiale intraoperatively, after conservative options were unsuccessful.