![]() Reported another variant of Maisonneuve fracture characterized by rupture of the deltoid ligament and AITFL with dislocation of the proximal tibiofibular joint, without the proximal fibular fracture. The author suggested that it might be caused by ankle plantarflexion combined with external rotation, or supination–external rotation with a small degree of plantar flexion. Reported a case of atypical Maisonneuve fracture, which was confirmed by X‐ray and magnetic resonance imaging (MRI) examinations as: fracture of the fibular neck fracture of the posterior malleolus and partial rupture of the AITFL and anterior talofibular ligament, without rupture of the deltoid ligament and fracture of the medial malleolus. Previous studies reported that the medial structure remained intact without rupture of the deltoid ligament or fracture of the medial malleolus in the case of Maisonneuve fracture, suggesting that supination–external rotation could also lead to Maisonneuve fracture Mostly identified proximal fibular fracture, injury of the tibiofibular syndesmosis, and medial structure as the essential characteristics of Maisonneuve fracture, whether this kind of fracture is definitely associated with medial structural injuries is still controversial. However, the imaging findings of Maisonneuve fracture were not constantly in clinic, although many authors If the violence persists, it may lead to the avulsion fracture of the posterior tibial tubercle or the rupture of the posterior inferior tibiofibular ligament (PITFL). Once injured, the medial structure is first affected, including the fracture of the medial malleolus or the rupture of the deltoid ligament, followed by the rupture of the anterior inferior tibiofibular ligament (AITFL) or avulsion fracture of the attachment point, the rupture of the interosseous ligament (IOL), the rupture of the interosseous membrane (IOM), and the fracture of proximal fibula in turn. ![]() , belonging to stage III or IV pronation–external rotation mechanism according to Lauge–Hansen classification Most authors conclude that the injury mechanism of Maisonneuve fracture is pronation–external rotation injury , which are rare in clinic, accounting for about 5% of the ankle fractures treated by surgery A proximal fibular fracture associated with rupture of the tibiofibular syndesmosis and the anterior fibers of the deltoid ligament caused by external rotation mechanism was described for the first time in 1840 on the basis of experiments by the French surgeon Jules Germain Francois Maisonneuve Maisonneuve fracture is a special type of ankle injury. The features of proximal fibular fracture, injuries of the medial and posterior structures of the ankle, injuries of the anterior inferior tibiofibular ligament and the interosseous membrane were recorded and analyzed. Forty patients were treated with open reduction and internal fixation. MRI examination of the ankle and calf was performed in 28 and five patients, respectively. CT scan of the ankle was performed in 38 patients, including three‐dimensional reconstruction in 33 patients. All patients underwent posteroanterior and lateral X‐ray examinations of the ankle and calf. The cause of injuries were traffic accident in five patients, sprain injury in 20 patients, and falling injury from height in 16 patients. There were 32 males and nine females, the average age was 37.9 years (range, 18 to 61 years), the fractures occurred on the left side in 20 patients and on the right side in 21 patients. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants.Ĭite this article: Bone Joint J 2019 101-B:512–521.The data of 41 patients with Maisonneuve fracture from April 2014 to September 2019 were retrospectively analyzed. However, there is recent evidence to suggest that nonoperative management of well-reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades.
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