Avulsion of the Chaput tubercle was detected in four cases. Posterior malleolar fractures were classified as type 1 in eight cases and type 2 in three cases. Injury to the deltoid ligament was revealed in six cases a bicollicular fracture of the medial malleolus was found in five patients. The proximal fibular fracture was described as a subcapital oblique spiral fracture with metadiaphyseal involvement in nine cases and a high short oblique fracture with fibular head involvement in two cases. Individual lesions of ankle structures were described on the basis of radiographs, CT, and intraoperative findings.ResultsThe distal fibular fracture was classified as Weber type B in 1 case and Weber type C in 10 cases. The study comprised 11 patients, 5 men and 6 women, with the mean age of 57 years (range, 21–87), with a “Double Maisonneuve fracture”. PurposeThe aim of this study was to describe pathoanatomy and to raise awareness of a fracture of the lateral malleolus combined with a high subcapital fracture of the fibula caused by a dislocation mechanism.Methods Therefore, CT examination is an indispensable part of assessment of this type of fracture. Maisonneuve fracture includes a wide range of injuries both to bone and ligamentous structures of the ankle. Osteochondral fracture of the talar dome was diagnosed in 2 patients and compression of the articular surface of the distal tibia in the region of the fibular notch in 1 patient. A fracture of the posterior malleolus occurred in 54 (77%) patients. A fracture of the medial malleolus was identified in 27 cases (39%) and a complete lesion of the deltoid ligament in 36 cases (51%) in 7 cases (10%) the medial structures were intact. An injury to the anterior and posterior tibiofibular ligaments was found in all 54 patients with open reduction of the distal fibula. Posterior dislocation of the fibula (Bosworth fracture) and tibiofibular diastasis were recorded in 2 cases each. Widening of the tibiofibular clear space was shown by radiographs in 40 cases. In 24% of the patients, the fibular fracture was seen only in the lateral radiograph of the lower leg. In 64 cases, the fibular fracture was subcapital, and in 6 cases it involved the fibular head. After the age of 50, the share of women significantly increased. The highest MF incidence rate was recorded in the 5th decade in the whole group and in men, while in women the peak incidence was in the 6th decade. Operative treatment was used in 67 patients open reduction of the distal fibula into the fibular notch was opted for in 54 of them. A total of 59 patients underwent CT examination in three views, including 3D CT reconstruction in 49 of these patients. Ankle radiographs in three views and lower leg radiographs in two views were performed in all patients. The group comprised 70 patients (47 men, 23 women), with the mean age of 48 years, who sustained an ankle fracture-dislocation involving the proximal quarter of the fibula. For these reasons we have decided to perform a study on MF epidemiology and pathoanatomy. However, details about this type of injury can be found only rarely in the literature. He returned to work without complications 3 months after surgery.Maisonneuve fracture (MF) is a generally known entity in ankle trauma. 3 This patient underwent suture button fixation of tibiofibular syndesmosis ( figure 2). 2 Because delayed surgical intervention prolongs ankle pain, open reduction and internal fixation are generally performed. 1 Syndesmosis injuries involve multiple ligaments between the distal tibia and fibula restoring their association is key to effective treatment. Maisonneuve fracture typically involves deltoid ligament rupture, tibiofibular ligament disruption and a spiral fracture of the proximal fibula.
![maisonneuve fracture maisonneuve fracture](http://www.wikiradiography.net/images/3/3b/R4r9T0M1OFb_K-r3I3lX5g342136.jpeg)
![maisonneuve fracture maisonneuve fracture](https://medpix.nlm.nih.gov/images/full/synpic25593.jpg)
Plain, full-length tibial and fibular radiography revealed an oblique fracture through the proximal diaphysis of the left fibula ( figure 1).
#Maisonneuve fracture manual#
Further examination at our hospital showed medial malleolus and left proximal fibula tenderness pain on manual compression of the proximal tibia and fibula suggested tibiofibular syndesmosis injuries. A healthy, 41-year-old man sustained a left ankle injury, resulting in persistent pain that was initially diagnosed as an ankle sprain without radiographic abnormalities.