Maisonneuve-Hyperplantarflexion Variant Ankle Fracture

Abstract

Maisonneuve fractures are rare ankle injuries, accounting for up to 7% of all ankle fractures. They consist of a proximal third fibula fracture, syndesmotic disruption, and medial ankle injury (either a deltoid ligament disruption or a medial malleolus fracture), and are often successfully managed with nonoperative treatment of the proximal fibula fracture and open reduction and internal fixation (ORIF) of the medial ankle injury and syndesmotic disruption. The hyperplantarflexion variant ankle fracture comprises approximately 7% of all ankle fractures and features dual posterior tibial lip fractures featuring a posterolateral fragment and a posteromedial fragment. Good functional results have been reported in the literature after ORIF of both the posterolateral and posteromedial fragments of this variant fracture that is not described by the Lauge-Hansen classification. In this report, the authors present the unique case of an isolated ankle fracture demonstrating characteristics of both a Maisonneuve fracture and a hyperplantarflexion variant ankle fracture. They also highlight the diagnostic imaging characteristics, including magnetic resonance imaging (MRI) and preoperative radiograph findings, surgical treatment, and postoperative clinical outcome for this patient with a Maisonneuve-hyperplantarflexion variant ankle fracture. To the authors' knowledge, this unique fracture pattern has not been reported previously in the literature. The authors conclude that although good results were seen postoperatively in this case, the importance of ORIF of both the posteromedial and posterolateral fragments of variant fractures cannot be overstated. They also found MRI to be a particularly helpful adjunct in formulating the correct diagnosis and treatment plan.

Maisonneuve Fractures of the Ankle

“…Charopoulos et al described a partial rupture of the anterior talofibular ligament on MRI in a patient with an MF, a PM fracture, and intact medial structures 22 . Hinds et al presented a similar case 24 . These observations point to a supination injury in at least some cases.…”

Lesão variante de Maisonneuve com luxação tibiofibular proximal

“…Maisonneuve lesion, first described in 1840 by the surgeon Jules Germain François Maisonneuve, accounts for 7% of all ankle fractures. 3 The trauma mechanism involves an external rotation associated with ankle pronation, resulting in an injury of the distal tibiofibular ligament, syndesmotic complex, and proximal fibular fracture. In one variant, there is concomitant dislocation of the proximal tibiofibular joint and distal ankle syndesmosis in the absence of a proximal fibular fracture.…”

“…In one variant, there is concomitant dislocation of the proximal tibiofibular joint and distal ankle syndesmosis in the absence of a proximal fibular fracture. 3…”

“…A lesão de Maisonneuve, primeiramente descrita em 1840 pelo cirurgião Jules Germain François Maisonneuve, corresponde a 7% de todas as fraturas do tornozelo. 3 O mecanismo de trauma envolve uma rotação externa associada a pronação do tornozelo, o que leva a lesão do ligamento tibiofibular distal, do complexo sindesmótico e fratura do terço proximal da fíbula. Uma das variantes desta lesão corresponde a uma luxação concomitante na articulação tibiofibular proximal e da sindesmose distal do tornozelo na ausência de fratura do terço proximal da fíbula.…”

“…Uma das variantes desta lesão corresponde a uma luxação concomitante na articulação tibiofibular proximal e da sindesmose distal do tornozelo na ausência de fratura do terço proximal da fíbula. 3…”