Maisonneuve fracture

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  • 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 Fractures


  • 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
Maisonneuve fracture


  • Usually requires surgical intervention (syndesmotic screws; proximal fibular fracture usually requires no fixation)
  • Long leg posterior splint with reduction of medial ankle and syndesmotic clear space


  • May depend on degree of associated ankle injury
  • If splinted and stabilized, can be discharged after consultation with Ortho
    • Will need close follow-up for likely operative repair
  • Admit for:
    • Open fracture
    • Signs of neurovascular injury
    • Concern for compartment syndrome

See Also



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