Maisonneuve Fracture

Description

The Maisonneuve fracture is a spiral fracture of the upper third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane.

There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament

Rupture of the stabilizing ligaments of the distal tibiofibular syndesmosis will result in widening of the ankle mortise on radiographs. Additional findings such as avulsion fracture of the medial or posterior malleoli, or tear of the deltoid ligaments may also be present

History

1840 – Maisonneuve described, using cadaveric studies, how an external rotation force applied to the foot could result in a fracture of the proximal third of the fibula

Associated Persons

• Jacques Gilles Maisonneuve (1809-1897)

Controversies

• In the case of an isolated medial malleolar fracture or medial ankle ligament rupture, a proximal fibula fracture (indicative of a rupture of the syndesmosis and interosseous membrane, should be excluded [J Emerg Med. 2013;44(2):e251-5]
• Fracture of the proximal fibula as a result of a pronation external rotation or supination external rotation mechanism of the foot and ankle should be differentiated from an isolated fibula fracture caused by direct force transmission from the lateral aspect.
• Maisonneuve fractures should be suspected whenever there is lateral talar displacement or tibiofibular widening without distal fibula fracture. Stress radiographs and full-length tibiofibular radiographs should be obtained

References

• Maisonneuve JG. Recherches sur la fracture du péroné. Archives générales de médecine 1840;7:165-187 and 433-473
• Pankovich AM. Maisonneuve fracture of the fibula. J Bone Joint Surg Am. 1976 Apr;58(3):337-42. [PMID 816799]
• Israeli A, Horoszowski H, Chechick A, Farine I. Beware the “simple” fibular fracture (a clue for severe unstable ankle injury. Br J Sports Med. 1981 Dec; 15(4): 269–271. [PMC1858905]
• Hanson JA, Fotoohi M, Wilson AJ. Maisonneuve fracture of the fibula: implications for imaging ankle injury. American Journal of Roentgenology. 1999;173: 702-702.
• Kalyani BS, Roberts CS, Giannoudis PV. The Maisonneuve injury: a comprehensive review. Orthopedics. 2010 Mar;33(3):190-5. [PMID 20205369]
• Millen JC, Lindberg D. Maisonneuve fracture. J Emerg Med. 2011 Jul;41(1):77-8. [PMID 19157747]
• Stufkens SA, van den Bekerom MP, Doornberg JN, van Dijk CN, Kloen P. Evidence-based treatment of Maisonneuve fractures. J Foot Ankle Surg. 2011 Jan-Feb;50(1):62-7 [PMID 21172642]
• Taweel NR, Raikin SM, Karanjia HN, Ahmad J. The proximal fibula should be examined in all patients with ankle injury: a case series of missed maisonneuve fractures. J Emerg Med. 2013 Feb;44(2):e251-5. [PMID 23079149]