"Floating Fibula" Secondary to Traumatic Dislocation of the Ankle Joint, Ankle Syndesmosis, and the Proximal Tibiofibular Joint: A Case Report.

Abstract

The Maisonneuve fracture, described by Dr. Jules Germain Francois Maisonneuve in 18401, is a fracture of the proximal part of the fibula that is associated with an injury to the ankle. This is also known as a pronation-external rotation injury to the ankle that disrupts the medial ankle structures initially and propagates along the syndesmotic ligaments and interosseous membrane and then exits, with a resultant fracture in the proximal part of the fibula2. Many authors have described variations of this injury3-5. Levy et al. described a single case report of a medial malleolar avulsion injury that did not have a proximal fibular fracture, but there was disruption of the ankle syndesmosis and proximal tibiofibular dislocation4. We report a case of traumatic ankle dislocation, syndesmosis disruption, and dislocation of the proximal tibiofibular joint, without fracture of the tibia or fibula. To our knowledge, this type of injury has not been previously reported. We also highlight some of the challenges faced while managing this interesting injury. The patient was informed that data concerning the case would be submitted for publication, and he provided verbal consent. A twenty-two-year-old motorcyclist, struck on the right side by a car, was knocked to the ground and sustained an open dislocation of the left ankle. There was a 7-cm open wound over the medial aspect of the ankle communicating with the ankle joint (Fig. 1), and a 2-cm wound over the lateral aspect of the ankle (Fig. 2). A third medial wound, measuring 10 cm, with an extensive degloving component was located on the proximal part of the leg. This wound was not communicating with the knee joint or the proximal tibiofibular joint. There was no neurovascular deficit in the left lower limb. Radiographs showed a complete …