Maisonneuve fracture

Case contributed by Dr Henry Knipe

Presentation

Mechanical fall with "popping" sound in ankle. Right medial ankle tenderness. Tenderness in right fibula head.

Patient Data

Age: 77
Gender: Female
X-ray

Whole leg

Undisplaced spiral fracture through the proximal fibula. Undisplaced transverse fracture through the medial malleolus. Distal tibiotalar joint appears intact. 

Annotated image

Arrows indicate position of fractures. 

X-ray

This study is a "stitched" CR image

In addition to the fractures, there is a "stitching line" (indicated by arrows). This causes an artefact in which there appears to be a cortical defect in the fibula, which could be mistaken for a fracture line. There is also linear increased density in the soft tissues adjacent, also an artefact. 

Case Discussion

The combination of a proximal-third fibula fracture and medial malleolus fracture has the eponymous name of a Maisonneuve fracture

This case also demonstrates the importance of two orthogonal views to detect and/or confirm the location of pathology. When reading CR or DR images it is important to be aware that some long-leg views are automatically stitched together and if this is imperfect, artefacts that mimic pathology may occur. 

The patient required operative management with two medial malleolus screws and a diastasis screw. 

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Case information

rID: 23312
Case created: 4th Jun 2013
Last edited: 7th Sep 2016
Inclusion in quiz mode: Included

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