Maisonneuve fracture: a type of ankle fracture
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* Ryota Inokuchi
* Yasuyuki Jujo
* Kosui Iwashita
* Masato Takao

*   primary care
*   orthopaedics

## Description

A healthy, 41-year-old man sustained a left ankle injury, resulting in persistent pain that was initially diagnosed as an ankle sprain without radiographic abnormalities. Further examination at our hospital showed medial malleolus and left proximal fibula tenderness; pain on manual compression of the proximal tibia and fibula suggested tibiofibular syndesmosis injuries. Plain, full-length tibial and fibular radiography revealed an oblique fracture through the proximal diaphysis of the left fibula (figure 1). Maisonneuve fracture typically involves deltoid ligament rupture, tibiofibular ligament disruption and a spiral fracture of the proximal fibula.1 Syndesmosis injuries involve multiple ligaments between the distal tibia and fibula; restoring their association is key to effective treatment.2 Because delayed surgical intervention prolongs ankle pain, open reduction and internal fixation are generally performed.3 This patient underwent suture button fixation of tibiofibular syndesmosis (figure 2). He returned to work without complications 3 months after surgery.

![Figure 1](http://casereports.bmj.com/https://casereports.bmj.com/content/bmjcr/12/11/e231961/F1.medium.gif)

[Figure 1](http://casereports.bmj.com/content/12/11/e231961/F1)

Figure 1 
Left tibia-fibula anterior-posterior X-ray showed proximal fibula spiral fracture (arrow).

![Figure 2](http://casereports.bmj.com/https://casereports.bmj.com/content/bmjcr/12/11/e231961/F2.medium.gif)

[Figure 2](http://casereports.bmj.com/content/12/11/e231961/F2)

Figure 2 
X-ray showed suture button fixation of tibiofibular syndesmosis.

### Learning points

*   Patient with ankle injuries should examine proximal fibula tenderness.

*   Maisonneuve fracture is unstable injuries and require the patient to consult an orthopaedic surgeon.

## Footnotes

*   Contributors YJ, KI and MT contributed to patient management. RI drafted the initial manuscript. MT critically reviewed manuscript. All authors contributed to writing the manuscript and have provided written consent for publication.

*   Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

*   Competing interests None declared.

*   Patient consent for publication Obtained.

*   Provenance and peer review Not commissioned; externally peer reviewed.

*   Accepted September 28, 2019.


*   © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.

## References

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2.  Taweel NR, Raikin SM, Karanjia HN, et al. The proximal fibula should be examined in all patients with ankle injury: a case series of missed maisonneuve fractures. J Emerg Med2013;44:e251–5.[doi:10.1016/j.jemermed.2012.09.016](http://dx.doi.org/10.1016/j.jemermed.2012.09.016)
    
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