Per literature, in Maisonneuve fracture, the most common inciting event is an injury that causes forceful external rotation and extroversion at the ankle joint.

The initial injury is often fracture of medial malleolus of the ankle followed by rupture of anterior syndesmosis and then high fibular fracture. There is significant distraction at the distal tibio-fibular joint space.

Further evaluation with additional cross-sectional imaging is recommended to assess the degree of ligamentous injury and any additional associated fractures of tarsals.