Maisonneuve fracture

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 syndesmosisdeltoid ligament) and/or fracture of the medial malleolus. It is caused by pronation external-rotation mechanism.

Ankle views may either show a fracture of the medial malleolus or widening of the ankle joint due to disruption of the distal tibiofibular syndesmosis (lateral talar shift) or deltoid ligament complex.

When these ankle injury types are seen, further imaging of the entire fibula is recommended to assess for an accompanying proximal fibular shaft fracture.

Although management is variable depending on complexity of injuries, this type of fracture pattern is generally managed by operative treatment. Specific aims generally include:

  1. 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
  2. reduction and stabilization of medial malleolus fracture and/or ligamentous injuries 6
    • ​​ligamentous injuries may be managed non-operatively
  3. reduction and stabilization of fibular fracture
    • fracture involving distal 2/3 of fibula may compromise ankle mortise, and so may benefit from surgery 6
    • fracture involving proximal 1/3 fibula often managed non-operatively

It is named after Jules Germain Francois Maisonneuve, French surgeon (1809-1897) 1,4.

Fractures
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Article information

rID: 7999
Synonyms or Alternate Spellings:
  • Maisonneuve's fracture
  • Maisonneuve fractures

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