Maisonneuve Fracture Associated With a Bimalleolar Ankle Fracture–Dislocation: A Case Report

Abstract

The Maisonneuve fracture consists of a proximal fibular fracture with associated syndesmotic ligament disruption and injury to the medial ankle structures. The accepted mechanism of injury is an external rotation force applied to the ankle with the foot in either supination or pronation. Because most Maisonneuve fractures involve complete syndesmotic disruption, operative treatment is usually indicated. A case report is presented of an unusual fracture pattern-i.e., that of a distal fibular fracture with lateral ankle dislocation associated with a Maisonneuve fracture. To our knowledge, only two other similar cases are reported in the English literature.

A 72-Year-Old Patient with Bilateral Maisonneuve Fractures

“…However numerous injuries deviating from the classical fracture scheme are described, like the combination with lateral ankle dislocation, showing a triplane fracture pattern in the adolescent or in association with an additional distal fibula fracture. 7–9 …”

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

“…Levy et al reported a case of an avulsion injury of the medial malleolus with disruption of the deltoid ligaments and dislocation of the proximal tibiofibular joint [7]. Furthermore there are few reports about distal fibular fractures with associated proximal fibular fracture [5,6]. As a dislocation of the proximal fibula is a rare entity the importance of precise history making and careful standardized examination with a high level of clinical suspicion cannot be overestimated [16].…”

Talocrural Dislocation With Associated Weber Type C Fibular Fracture in a Collegiate Football Player: A Case Report

“…3,5,6,[18][19][20] Few of the published case studies of ankle dislocation and fibula fracture are sport related. [7][8][9][10][11][12]14,[20][21][22][23][24] Of those cases, few authors 25 discuss the occurrence in high-level football athletes.…”

“…External rotation of the ankle, paired with either pronation or supination, can place the ankle joint in a vulnerable position for dislocation or fracture (or both). 1,4,13,16,18,20,22 Many injury classification methods use the mechanism of injury to determine the extent of damage. 5,17,18 The Weber classification method uses the level of fibular fracture to classify the injury.…”

“…26 A Maisonneuve fracture (a Weber type C fracture) occurs in the proximal fibula when the distal tibiofibular syndesmosis ruptures and either the deltoid ligament fails or the medial malleolus fractures. 20,22 This injury is caused by excessive ankle external rotation. 20,22,27 Open reduction and internal fixation techniques help to restore fibular integrity and ankle mortise stability in a relatively low, Weber type C fracture pattern.…”