MANUAL MINORS
A Maisonneuve fracture is a complex ankle injury involving a fracture of the proximal third of the fibula, accompanied by a rupture of the syndesmotic ligament (which connects the tibia and fibula) and often a fracture of the medial malleolus or a rupture of the deltoid ligament in the ankle.
This fracture is typically caused by a violent twisting mechanism of the ankle, which transfers force from the ankle to the proximal fibula, resulting in the fracture.
Diagnosis
The diagnosis of a Maisonneuve fracture is made through a combination of clinical history and imaging studies. Patients typically present with pain and swelling in the ankle, though there may also be tenderness in the upper leg, near the knee, due to the proximal fibula fracture.
An X-ray of the ankle and leg is essential to identify the proximal fibular fracture and assess the integrity of the ankle joint. Magnetic resonance imaging (MRI) or computed tomography (CT) can be helpful to evaluate ligament injuries.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Isolated Malleolar Fracture | Localised pain and swelling in the ankle, without involvement of the proximal fibula |
Ankle Sprain | Localised pain and swelling in the ankle joint, no bone fracture |
Isolated Proximal Fibula Fracture | Localised pain in the upper leg, without ankle involvement |
Fibular Shaft Fracture | Localised pain in the middle fibula, without significant ankle instability |
Deltoid Ligament Rupture | Ankle instability with medial pain, without associated bone fracture |
Emergency Management
In the emergency department, initial management of a Maisonneuve fracture includes immobilising the ankle and the affected leg to prevent further injury, along with administering analgesics for pain control.
Careful assessment of the neurovascular status of the foot is crucial, as vascular or nerve injuries may be associated with this fracture. Open or displaced fractures require urgent intervention, and an orthopaedic consultation is critical to plan definitive management.
Definitive Treatment
Maisonneuve fractures generally require surgical intervention due to significant ankle instability from the syndesmotic ligament rupture. Surgery involves fixing the ankle with screws or plates and stabilising the proximal fibula if necessary.
After surgery, the patient will need to wear a boot immobiliser and engage in a rehabilitation programme to restore ankle mobility and strength. Non-displaced or less severe fractures may be managed conservatively with immobilisation, but this is less common in this type of injury.
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