Maisonneuve fracture: Difference between revisions
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==Background== | ==Background== | ||
[[File:Slide1dede.png|thumb|Anatomy of lower leg showing interosseous membrane.]] | |||
*Lower extremity equivalent of [[Galeazzi fracture]] | *Lower extremity equivalent of [[Galeazzi fracture]] | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Maisonneuve fracture Fibula.png|thumb|Maisonneuve fracture of the proximal fibula.]] | |||
[[File:Maisonneuve fracture.jpg|thumb|Maisonneuve fracture]] | |||
*Assess distal pulse, motor, and sensation | *Assess distal pulse, motor, and sensation | ||
*Inspect skin for signs of open fracture | *Inspect skin for signs of open fracture | ||
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**High fibular fracture | **High fibular fracture | ||
*Signs of[[Ankle syndesmosis injury| syndesmotic injury]] | *Signs of[[Ankle syndesmosis injury| syndesmotic injury]] | ||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*[[Long leg posterior splint]] with reduction of medial ankle and syndesmotic clear space | *[[Long leg posterior splint]] with reduction of medial ankle and syndesmotic clear space | ||
Latest revision as of 22:26, 2 August 2023
Background
- Lower extremity equivalent of Galeazzi fracture
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
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- Foot and toe fractures
Evaluation
- 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
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Long leg posterior splint with reduction of medial ankle and syndesmotic clear space
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]
- Open fracture
- Signs of neurovascular injury
- Concern for compartment syndrome
Specialty Management
- Usually requires surgical intervention (syndesmotic screws; proximal fibular fracture usually requires no fixation)