The Proximal Fibula Should Be Examined In All Patients with Ankle Injury: A Case Series of Missed Maisonneuve Fractures

Taweel, Nicholas; Raikin, Steven M.; Karanjia, Homyar; Ahmad, Jamal

doi:10.1016/j.jemermed.2012.09.016

Cited by 21 publications

(11 citation statements)

References 8 publications

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“…Physical examination revealing medial tenderness has been shown to have poor positive predictive value for significant deltoid injury [12]. It is vital to assess for proximal fibular tenderness in order to rule out Maisonneuve fractures [13]. Soft tissue palpation of all the ligamentous structures should be performed.…”

Section: Diagnosismentioning

confidence: 99%

Ankle Fractures: A Literature Review of Current Treatment Methods

Singh¹,

Kamal²,

Roulohamin³

et al. 2014

OJO

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Ankle fracture is one of the most common lower limb fractures for they account for 9% of all fractures representing a significant portion of the trauma workload. Ankle fractures usually affect young men and older women, however, below the age of 50; ankle fractures are the commonest in men. Two commonly used classification systems for ankle fractures include the danis weber AO classification and the Lauge-Hansen classification. There is biomechanical evidence that posterior non-locking plates are superior in stability than laterally placed plates; however there is little clinical evidence. There are several different methods of ankle fracture fixation, however the goal of treatment remains a stable anatomic reduction of talus in the ankle mortise and correction of the fibula length as a 1 mm lateral shift of the talus in the ankle mortise reduces the contact area by 42%, and displacement (or shortening) of the fibula more than 2 mm will lead to significant increases in joint contact pressures. Further research both biomechanically and clinically needs to be undertaken in order to clarify a preferable choice of fixation.

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Section: Diagnosismentioning

confidence: 99%

Ankle Fractures: A Literature Review of Current Treatment Methods

Singh¹,

Kamal²,

Roulohamin³

et al. 2014

OJO

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“…Clinicians should be suspicious of a Maisonneuve fracture pattern when there is an isolated fracture of the posterior tibial tubercle, evidence of deltoid ligament disruption or fracture of the medial malleolus in the absence of a lateral malleolar fracture, or if there is tenderness over the anteromedial capsule of the syndesmosis or the syndesmosis itself . Several case studies have reported missed Maisonneuve fractures due to a lack of assessment of the proximal fibula . Prompt recognition of this injury pattern is imperative so that surgical fixation is not delayed and untoward consequences are avoided.…”

Section: Discussionmentioning

confidence: 99%

Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series)

Strudwick

McPhee

Bell

et al. 2017

Emerg Medicine Australasia

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Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English language articles published in the last 12 years that addressed the acute assessment, management or prognosis in the ED were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1242 articles, of which 71 were included in the review (n = 22 primary articles, n = 35 systematic reviews and n = 14 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the ankle and foot in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. Following a thorough history and physical examination, including the application of the Ottawa ankle rules, ED clinicians should not only provide a diagnosis, but rate the severity of soft tissue injuries, or stability of fractures and dislocations, which are the pivotal decision points in guiding ED treatment, specialist referral and the follow-up plan.

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“…Maisonneuve fracture typically involves deltoid ligament rupture, tibiofibular ligament disruption and a spiral fracture of the proximal fibula 1. Syndesmosis injuries involve multiple ligaments between the distal tibia and fibula; restoring their association is key to effective treatment 2. Because delayed surgical intervention prolongs ankle pain, open reduction and internal fixation are generally performed 3.…”

Section: Descriptionmentioning

confidence: 99%