Maisonneuve fracture equivalent with proximal tibiofibular dislocation. A case report and literature review.

The Maisonneuve fracture was initially described in 1840 by Dr. Jacques Maisonneuve1. The initial description involved a proximal fibular fracture associated with an injury to the medial ankle structures. Lauge-Hansen then classified this fracture as a pronation-external rotation variant, with disruption of the syndesmosis2. Danis3 and Weber4 classified these injuries as type-C fractures, and the AO/ASIF Group described them as type-C3 injuries5. This pronation-external rotation mechanism involves either an avulsion fracture of the medial malleolus or disruption of the deltoid ligaments. This is followed by an external rotation force that causes disruption of the syndesmotic ligaments and the interosseous membrane. The energy pattern continues along the path of the interosseous membrane and exits in the proximal fibular region. Proximal tibiofibular dislocation initially was described by Dubreuil6 in 1844 and then by Malgaigne in 18557. Fig. 1 Stress radiograph of the left (injured) ankle, showing the medial clear space of 5.4 mm and the talocrural angle of 6.2°. We present the case of a patient who sustained a pronation-external rotation injury involving an avulsion of the medial malleolus, with disruption of the deltoid ligaments and the proximal tibiofibular joint. There was no fibular fracture, but the patient did sustain an ipsilateral tibiofibular dislocation. On the basis of our review of the literature, we do not believe that this association has been described previously. The patient was informed that data concerning this case would be submitted for publication. Aseventeen-year-old boy presented to the emergency room after a twisting injury of the left ankle. Initially, he was thought to have an ankle sprain with no evidence of fracture. The patient was managed with a splint because of severe soft-tissue swelling and was referred to the orthopaedic surgery department. Fig. 2 Stress radiograph of the right (uninjured) …

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