Case 63 - Maisonneuve fracture

Summary

Imaging description

Maisonneuve fracture has been described for the ankle injury characterized by a high fibular fracture with disruption of the tibiofibular syndesmosis. The diagnosis of a Maisonneuve fracture should be considered in each of the following situations: (1) widening of the medial or lateral clear space without evident fracture (Figure 63.1); (2) an apparent isolated displaced fracture of the medial malleolus; and (3) an apparent isolated fracture of the posterior malleolus (Figure 63.2). On such occasions, full-length views of the tibia and fibula should be obtained to identify the high fibular fracture. Stress radiography of the ankle may help for subtle cases of medial clear space widening. Lack of overlap of the distal fibula with the tibial tuberosity is a helpful sign for syndesmotic injury.

Importance

Maisonneuve fracture is considered as a severe ankle injury with syndesmotic disruption. The diagnosis is often delayed or missed because the patients rarely report pain in the proximal fibula most likely due to the presence of a more painful ankle injury. Early operative treatment is recommended for the majority of patients with Maisonneuve fracture. Therefore, recognizing the injury pattern of Maisonneuve fracture from ankle radiographs is important for a correct diagnosis. Radiologists should recommend radiographic evaluation of the entire tibia and fibula to confirm the proximal extent of the injury.