Maisonneuve Fractures of the Ankle

Abstract

Maisonneuve fractures (MFs), originally described as subcapital (high) fibular fractures with additional injury to the anterior and interosseous tibiofibular ligaments, display a variable injury pattern, ranging from stable to highly unstable fractures.The high incidence of associated fractures of the posterior malleolus, the medial malleolus, and the anterolateral distal tibia (the “anterior malleolus”) as well as the variable position of the fibula in the fibular notch (FN) warrant preoperative examination via computed tomography (CT).The main goal of treatment is anatomic reduction of the distal fibula into the FN, which requires prior reduction of displaced posterior malleolar fractures, if present, to restore the integrity of the FN.Open reduction of the distal fibula into the FN and fixation with 2 transsyndesmotic screws or fixation with a screw(s) and suture-button implant, under direct vision, on the lateral aspect of the ankle joint and anterior tibiofibular alignment are preferred over closed reduction to avoid sagittal or rotational malpositioning, which is associated with an inferior outcome.Intra- or postoperative 3D CT visualization is essential for assessment of the accuracy of the reduction of the distal fibula into the FN.

Comparison of Radiological, Functional and Plantar Pressure Disturbance Results of Two Different Surgical Techniques on Syndesmosis Injuries with Malleolus Fractures

“…In the present study, the mean AOFAS score of the EndoButton group was 92.33 and 85 in the Screw Group. It was observed in the literature that EndoButton scores are between 85.57 and 97 and between 75 and 92 in screw fixation groups (7)(8)(9)(10)(11)(12)(13)(14). The results in this study are therefore similar to the literature.…”

Pediatric Maisonneuve and Tillaux Fractures with Lateral Ankle Dislocation: A Pediatric “Logsplitter” Injury

“…The mechanism of injury of MF has been mostly described as pronation with external rotation (PER), although occasionally it can be supination with external rotation (SER) associated with plantar flexion of the ankle, 1 whereas the mechanism of injury of the Tillaux fracture is SER. The mechanism of injury in our case was probably PER starting with the deltoid injury, followed by the Tillaux fracture, disruption of AITFL and interosseous ligament, proximal fibula fracture, and ankle dislocation, although SER injury cannot be ruled out.…”

“…We report a pediatric logsplitter injury pattern of pediatric MF, Tillaux fracture, and transsyndesmotic ankle dislocation that was successfully treated with prompt reduction of the dislocation and surgical anatomic reduction and internal fixation, including syndesmotic stabilization. n Connor T. Wright, BA 1 Philip Hanna, MBCHB 1 Giovanna Medina, MD, PhD 1 Valerie Kiers, NP 1 Saechin Kim, MD, PhD 1 1 Department of Orthopaedic Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts E-mail address for S. Kim: skim1@mgb.org…”

“…A recent review 1 offered a definition of the Maisonneuve fracture (MF) 2 as a high-fibula fracture with at least the rupture of the anterior inferior tibiofibular ligament (AITFL) and interosseus tibiofibular ligament. The review also discussed different mechanisms of MF proposed by various authors, and external rotation was the common component among the mechanisms 1,3,4 .…”

“…A recent review 1 offered a definition of the Maisonneuve fracture (MF) 2 as a high-fibula fracture with at least the rupture of the anterior inferior tibiofibular ligament (AITFL) and interosseus tibiofibular ligament. The review also discussed different mechanisms of MF proposed by various authors, and external rotation was the common component among the mechanisms 1,3,4 . Dias and Tachdjian 5 found that distal tibial fractures in children due to external rotation injury included distal tibial Salter-Harris (SH) II fracture, Tillaux (SH III) fracture of the distal tibia lateral epiphysis, and triplane (SH IV) fracture in 3 different planes 5,6 .…”