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Maisonneuve fracture

Czech version

Authors: Š. Kašper 1;  J. Bartoníček 1;  K. Kostlivý 2;  J. Malík 3;  M. Tuček 1
Authors‘ workplace: 
Klinika ortopedie, 1. lékařská fakulta Univerzita Karlova a Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha 1;  Chirurgická klinika, 1. lékařská fakulta Univerzita Karlova a Thomayerova nemocnice 2;  Radiodiagnostické oddělení, Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha 3
Published in: Rozhl. Chir., 2020, roč. 99, č. 2, s. 77-85.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2020.99.2.77–85

Overview

Introduction: Maisonneuve fracture (MF) is a generally known entity in ankle trauma. However, details about this type of injury can be found only rarely in the literature. For these reasons we have decided to perform a study on MF epidemiology and pathoanatomy.

Methods: The group comprised 70 patients (47 men, 23 women), with the mean age of 48 years, who sustained an ankle fracture-dislocation involving the proximal quarter of the fibula. Ankle radiographs in three views and lower leg radiographs in two views were performed in all patients. A total of 59 patients underwent CT examination in three views, including 3D CT reconstruction in 49 of these patients. MRI was performed in 4 patients. Operative treatment was used in 67 patients; open reduction of the distal fibula into the fibular notch was opted for in 54 of them.

Results: The highest MF incidence rate was recorded in the 5th decade in the whole group and in men, while in women the peak incidence was in the 6th decade. After the age of 50, the share of women significantly increased. In 64 cases, the fibular fracture was subcapital, and in 6 cases it involved the fibular head. In 24% of the patients, the fibular fracture was seen only in the lateral radiograph of the lower leg. Widening of the tibiofibular clear space was shown by radiographs in 40 cases. Posterior dislocation of the fibula (Bosworth fracture) and tibiofibular diastasis were recorded in 2 cases each. An injury to the anterior and posterior tibiofibular ligaments was found in all 54 patients with open reduction of the distal fibula. A fracture of the medial malleolus was identified in 27 cases (39%) and a complete lesion of the deltoid ligament in 36 cases (51%); in 7 cases (10%) the medial structures were intact. A fracture of the posterior malleolus occurred in 54 (77%) patients. Osteochondral fracture of the talar dome was diagnosed in 2 patients and compression of the articular surface of the distal tibia in the region of the fibular notch in 1 patient.

Conclusion: Maisonneuve fracture includes a wide range of injuries both to bone and ligamentous structures of the ankle. Therefore, CT examination is an indispensable part of assessment of this type of fracture.

Keywords:

Maisonneuve fracture – ankle fractures – tibiofibular syndesmosis – posterior malleolus fracture

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