Lateral ankle fracture with missed proximal tibiofibular joint instability (Maisonneuve injury)

Abstract

We present a case of a soccer player who sustained a lateral ankle fracture and the associated proximal anterolateral tibiofibular joint instability (Maisonneuve injury) was overlooked. After a non-contact injury the (incomplete) diagnosis of a lateral malleolar fracture (type Weber B, AO 44-B1) was made and the patient was surgically treated with open reduction and internal fixation including a distal syndesmosis screw. After removal of the syndesmosis screw (six weeks after surgery) the patient suffered from activity-related pain around the fibular head. After thorough clinical and radiologic examination, temporary screw transfixation of the fibular head and capsular repair under meticulous fluoroscopic control of fibular rotation helped to restore patient's sport activity level. This case report emphasizes the importance of precise clinical examination for detection of a proximal tibiofibular joint instability. Restoration of a well functioning and stable proximal tibiofibular joint may be difficult to achieve in previously operated and missed instabilities.

Maisonneuve Fractures of the Ankle

“…Maisonneuve originally described a “subcapital fracture of the fibula associated with rupture of the anterior tibiofibular ligament.” 1 Some authors have extended this term to all fractures of the middle third or the proximal half of the fibula 15,21,26 . Others speak of “Maisonneuve-like” fractures in cases with an intact fibula (so-called “sprains of the tibiofibular joint”), with or without dislocation of the fibular head in the proximal tibiofibular joint 40-45 . Based on the analyses that have been published to date, an MF may be best defined as a fracture of the proximal quarter of the fibula that is combined, at least, with rupture of the anterior tibiofibular ligament (ATFL) and the interosseous tibiofibular ligament.…”