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Maisonneuve fracture refers to a combination of a fracture of the proximal fibula together with an unstable ankle injury (widening of the ankle mortise on x-ray), often comprising ligamentous injury (distal tibiofibular syndesmosis, deltoid ligament) and/or fracture of the medial malleolus. It is caused by a pronation-external rotation mechanism.
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Ankle views may show a fracture of the medial malleolus or widening of the medial ankle joint space due to deltoid ligament injury, as well as widening of the distal tibiofibular syndesmosis. When these ankle injury types are seen without a fracture of the lateral malleolus, further imaging of the entire fibula is recommended.
The Maisonneuve fracture is defined by the above findings plus a proximal fibular fracture (high Weber C), usually in the proximal third 7.
Treatment and prognosis
Although management is variable depending on the complexity of injuries, this type of fracture pattern is generally managed by operative treatment. Specific aims generally include:
internal fixation of the distal tibiofibular syndesmosis 6
commonly achieved by trans-syndesmotic screws. Alternative stabilization mechanisms exist (e.g. bioabsorbable constructs, syndesmotic staples, hooks, or cerclage wires)
in some cases, internal fixation of a posterior malleolar fracture fragment may result in sufficient stabilization
fixation screws may or may not be removed after several weeks of healing 6
reduction and stabilization of medial malleolus fracture and/or ligamentous injuries 6
ligamentous injuries may be managed non-operatively
reduction and stabilization of the fibular fracture
fracture involving distal 2/3 of the fibula may compromise ankle mortise, and so may benefit from surgery 6
fracture involving proximal 1/3 fibula often managed non-operatively
History and etymology
It is named after Jules Germain Francois Maisonneuve, French surgeon (1809-1897) 1,4.
- 1. Hunter TB, Peltier LF, Lund PJ. Radiologic history exhibit. Musculoskeletal eponyms: who are those guys? Radiographics. 20 (3): 819-36. Radiographics (full text) - Pubmed citation
- 2. Hanson JA, Fotoohi M, Wilson AJ. Maisonneuve fracture of the fibula: implications for imaging ankle injury. AJR Am J Roentgenol. 1999;173 (3): 702. AJR Am J Roentgenol (citation) - Pubmed citation
- 3. Forster BB, Lee JS, Kelly S et-al. Proximal tibiofibular joint: an often-forgotten cause of lateral knee pain. AJR Am J Roentgenol. 2007;188 (4): W359-66. doi:10.2214/AJR.06.0627 - Pubmed citation
- 4. Maisonneuve, J. G. (1840). Recherches sur la fracture du péroné. Paris. France: Loquin & Cie.
- 5. www.wheelessonline.com. Read relevant article. Accessed on 21/07/2016
- 6. Stufkens SA, van den Bekerom MP, Doornberg JN, van Dijk CN, Kloen P. Evidence-based treatment of maisonneuve fractures. (2011) The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 50 (1): 62-7. doi:10.1053/j.jfas.2010.08.017 - Pubmed
- 7. Pankovich AM. Fractures of the fibula proximal to the distal tibiofibular syndesmosis. (1978) The Journal of bone and joint surgery. American volume. 60 (2): 221-9. Pubmed