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]] | |||
===Components=== | ===Components=== | ||
| Line 14: | Line 15: | ||
{{Distal leg fractures DDX}} | {{Distal leg fractures DDX}} | ||
== | ==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 | |||
*Inspect skin for signs of open fracture | |||
*Long leg film that includes ankle | *Long leg film that includes ankle | ||
**Increase in medial clear space of ankle joint | **Increase in medial clear space of ankle joint | ||
**Tibiofibular clear space widened >5mm | **Tibiofibular clear space widened >5mm | ||
**High fibular fracture | **High fibular fracture | ||
*Signs of | *Signs of[[Ankle syndesmosis injury| syndesmotic injury]] | ||
[[ | |||
==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 | ||
==Disposition== | ==Disposition== | ||
''Depends on degree of associated ankle injury'' | |||
*If splinted and stabilized, can be discharged after consultation with ortho<ref>J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. PMID: 17548882</ref> | |||
**Will need close follow-up for likely operative repair | |||
*Admit for:<ref>J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. PMID: 17548882</ref> | |||
**[[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) | |||
==See Also== | ==See Also== | ||
*[[Ankle syndesmosis injury]] | |||
*[[Distal leg fractures]] | *[[Distal leg fractures]] | ||
==References== | ==References== | ||
<references/> | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
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)