Maisonneuve Fracture Research Articles

The Maisonneuve Fracture of the Fibula

Nine patients sustained a Maisonneuve fracture of the fibula (MFF), which is a proximal fibula fracture associated with an ankle fracture or deltoid ligament tear. Eight were treated with closed reduction and plaster casts. One was treated by open reduction and internal fixation. Reexamination was performed at an average of 25.7 months. This included subjective, objective, and functional evaluations, along with stress roentgenograms. Six patients had an excellent result, two a good result, and one a fair result. The MFF is often more stable than generally assumed. For injuries with only a partial syndesmotic disruption, nonoperative treatment is recommended.

Stabilization of ankle syndesmosis injuries with a syndesmosis screw.

A retrospective review was made of 30 patients who had disruption of the ankle syndesmosis that was treated at Santa Clara Valley Medical Center with a transfixation screw. Follow-up ranged from 3 months to 3 years. There were 21 pronation external rotation injuries and 9 Maison-neuve fractures. Screw size ranged from 3.5 cortical to 6.5 cancellous Synthes screws. Most were placed transversely from 1.5 to 3.5 cm above the joint line. Intraoperative difficulties with screw placement occurred in 2 patients, resulting in one bent screw and one screw placed directly into the ankle joint. Most patients were mobilized prior to screw removal; lucent lines developed around the syndesmosis screw before it was removed in two-thirds of the patients. No screw broke prior to removal. In 6 patients, calcification of the interosseous membrane was seen and, in 4, this progressed to a distal tibiofibular synostosis. It was found that transfixation screws provided satisfactory stability of the syndesmosis to permit stable healing of the interosseous membrane and distal ligaments after ankle fracture. Motion between the tibia and fibula developed despite screw fixation, as shown by the lytic bony changes that occurred with time.

Maisonneuve fracture: Case report of a missed diagnosis

We report the case of a Maisonneuve fracture of the fibula in which the diagnosis was initially missed. The patient presented with a chief complaint of medial ankle pain. Rentograms of the ankle were unremarkable, and the proximal fibula was not examined. He returned four days later with increased pain, at which time examination revealed tenderness along the proximal fibula and medial ankle. Roentgenograms showed widening of the medial joint space of the ankle and an oblique crush of the proximal fibula. The patient underwent open reduction and internal fixation of the syndesmosis and repair of the deltoid ligament, and recovered uneventfully. Physical examination of ankle injuries should include the proximal fibula.

Results of operative treatment of displaced external rotation-abduction fractures of the ankle.

One hundred and fifty patients with a displaced fracture of the ankle caused by external rotation-abduction forces were treated by open reduction and rigid internal fixation. After an average follow-up of three and one-half years, the results were satisfactory in 90 per cent. Less satisfactory results were noted in the more severely injured ankles. We found that the ruptured deltoid ligament did not need to be repaired if the lateral side was anatomically and rigidly fixed; in the Maisonneuve fracture, restoration of the fibular length was as important as stabilization of the fracture; with the use of the suprasyndesmotic screw, walking was permissible with the screw in situ; conforming the plate to the bend of the lateral malleolus was essential; and as much as two millimeters of lateral residual displacement of the lateral and medial malleoli was compatible with a satisfactory result, as was a similar displacement of the talus provided there was anatomical restoration of the lateral side.

Posterior fracture-dislocation of the distal part of the fibula. Mechanism and staging of injury.

The Bosworth fracture, a fixed posterior fracture-dislocation of the distal part of the fibula due to external rotation of the supinated foot, is a rare injury. In this report we review the literature, present two new cases, and describe our cadaver studies, showing that the initial stages of the injury are identical to those of a Maisonneuve fracture. The final stages that are unique to this fracture-dislocation are the posterior dislocation and fracture of the fibula and the fracture of the medial malleolus or rupture of the deltoid ligament. The objectives of treatment are reduction of the dislocation, repair and stabilization of the tibiofibular syndesmosis, and restoration of the ankle mortise to its anatomical position.

The Frenchman's fibular fracture (Maisonneuve fracture)

Two patients with injuries to the ankle sustained by rotational trauma complained only of pain in the ankle. Careful examination revealed tenderness over the proximal fibula. Subsequent radiographic studies revealed high helical fracture of the fibula, as originally described by Maisonneuve. The Maisonneuve fracture is produced by diastasis - a separation of bones resulting from rupture of ligaments around the ankle. According to classification of fibula injuries by mechanism of injury, the Maisonneuve fracture is due to external rotation of the foot relative to the tibia but it is not clear whether the foot is in pronation or supination or moves during injury.

Maisonneuve fracture of the fibula

Study of seventeen cases of Maisonneuve fracture established that there are five stages in the development of a complete lesion. A strong external-rotation force with the foot in slight supination is thought to be responsible for the initial stages; this may change to neutral or slight pronation in the later stages. This is a severe injury to the ankle, which includes complete diastasis of the distal tibiofibular syndesmosis and often rupture of the anteromedial joint capsule and deltoid ligament or fracture of the medial malleolus. Surgical treatment is necessary in later stages.