Maisonneuve fracture

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Background

Anatomy of lower leg showing interosseous membrane.

Components

  • Fibula fracture (anywhere from head or as far down as 6cm above ankle joint)
  • Deltoid ligament rupture or medial malleolus avulsion fracture
  • Injury then directed upward and laterally tearing interosseous membrane and anterior inferior tibiofibular ligament
  • May involve posterior tibiofibular ligament or posterior malleolar fracture

Clinical Features

  • Results from external rotation force applied to foot

Differential Diagnosis

Distal Leg Fracture Types

Evaluation

Maisonneuve fracture of the proximal fibula.
Maisonneuve fracture
  • Assess distal pulse, motor, and sensation
  • Inspect skin for signs of open fracture
  • Long leg film that includes ankle
    • Increase in medial clear space of ankle joint
    • Tibiofibular clear space widened >5mm
    • High fibular fracture
  • Signs of syndesmotic injury

Management

General Fracture Management

Specific Management

Disposition

Depends on degree of associated ankle injury

  • If splinted and stabilized, can be discharged after consultation with ortho[1]
    • Will need close follow-up for likely operative repair
  • Admit for:[2]

Specialty Management

  • Usually requires surgical intervention (syndesmotic screws; proximal fibular fracture usually requires no fixation)

See Also

References

  1. J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. PMID: 17548882
  2. J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. PMID: 17548882