UMEM Educational Pearls

Category: Orthopedics

Title: Maisonneuve Fracture

Keywords: maisonneuve, tibia, fibula, fracture, ankle, orthopedic (PubMed Search)

Posted: 11/2/2008 by Dan Lemkin, MD (Emailed: 11/8/2008) (Updated: 10/18/2019)
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A maisonneuve fracture is a fracture dislocation resulting from external rotational forces to ankle -- through interosseous ligament to fibula.

  • Proximal fibula fracture - from external rotational forces (spiral/oblique)
  • Ankle components can include any of the following:
    • medial maleolus avulsion fx or deltoid ligament rupture
    • anterior talofibular ligament rupture
    • interosseous ligament rupture
    • posterior malleolar fracture

If stability is questionable, orthopedic evaluation under anesthesia is required. Additionally always consider compartment syndrome. Do not rely on Kanduval's signs (pain, paraesthesia, pallor, poikilothermia, pulselessness) - "... with the exception of pain and paraesthesia, these traditional signs are not reliable." Emergent orthopedic consultation and compartment pressure assessment should be performed. (see attached photos)

 

References

  1. Maisonneuve Fracture. Wheeless Textbook of Orthopedics. http://www.wheelessonline.com/ortho/maisonneuve_fracture
  2. Paula, Richard. Compartment Syndrome, Extremity. www.EMedicine.com 2006. http://www.emedicine.com/EMERG/topic739.htm