Lesão variante de Maisonneuve com luxação tibiofibular proximal

Abstract

ResumoA lesão de Maisonneuve é uma entidade rara, correspondendo a 7% das fraturas de tornozelo. Uma de suas variantes inclui a lesão da sindesmose tibiofibular distal com luxação tibiofibular proximal, tornando-a uma injúria ainda mais incomum. O presente artigo apresenta o caso de um paciente de 34 anos admitido na emergência de traumato-ortopedia de hospital terciário com dor e edema em membro inferior esquerdo, após trauma esportivo. A radiografia do joelho evidenciou luxação anterolateral da articulação tibiofibular proximal com subluxação lateral do tornozelo, sem sinais de fratura. Após avaliação tomográfica do membro, confirmou-se o diagnóstico de uma lesão variante de Maisonneuve com luxação tibiofibular proximal. Os autores descrevem o caso, abordando aspectos clínicos, radiográficos e cirúrgicos desta variante.

Maisonneuve injury with no fibula fracture: A case report

“…When the transmitted force exceeds the limitation of upper tibiofibular syndesmosis, the superior tibiofibular joint is dislocated as a breakthrough point of the force, which is considered to be another kind of Maisonneuve-equivalent injury. Only five cases of that kind of Maisonneuve-equivalent injury have been reported in the literature[ 24 ]. According to the intensity of the transmitted force and the location of the breakthrough point, we further classified Maisonneuve injury as syndesmosis injury with IOM rupture (type I), syndesmosis injury with upper fibula fracture (type II), and syndesmosis injury with superior tibiofibular joint dislocation (type III).…”

Isolated, Proximal Tibiofibular Injuries in Athletic Patients: A Critical Analysis Review

“…15 In patients sustaining acute proximal TF injuries, an audible “pop” at the time of injury may be reported, 2 7 29 31 as well as the acute onset of anterolateral pain over the proximal leg. 1 7 15 16 28 31 Patients may report being unable to bear weight following injury 3 30 32 37 ; however, others have reported the ability to bear weight following injury. 7 34 A visual deformity at the proximal aspect of the lateral leg may also be reported at the time of injury, 15 28 31 which may become more pronounced with increasing knee flexion.…”

“…14 15 Due to the frequent traumatic nature of injury involving ankle rotation, patients may report concurrent pain to the ipsilateral ankle. 37 An appropriate history should also evaluate for any history of generalized ligamentous laxity (i.e., Ehlers–Danlos syndrome) or muscular dystrophy, as these conditions may increase the risk for recurrent instability. 20 25…”

“…3 15 34 Patients may display evidence of edema at the lateral malleolus in the setting of concomitant ankle injuries. 37…”

“…10 28 Radiographs of the bilateral ankles may also be obtained to evaluate for any medial clear space widening, lateral ankle subluxation, and changes in the talocrural angle to evaluate for a possible syndesmotic injury (i.e., Maisonneuve variant). 15 37…”