![]() According to two recent meta-analyses, there is, to date, insufficient evidence to say which modality is the best to treat an ankle fracture considered unstable ( 14, 15). Surgical or conservative methods are employed to allow the joint to heal in this sense. It is admitted that a syndesmosis lesion may be associated with a significant instability of the joint, which could lead to osteoarthritis if not adequately stabilized ( 13).įor ankle fractures in general, it is recognized that restoring anatomical congruence to the ankle joint is important to improve function and decrease post-traumatic osteoarthritis. Syndesmosis lesions reach a consensus in the literature for surgical treatment in case of diastasis of the distal tibiofibular joint or associated fracture around the ankle ( 10- 12). Maisonneuve fractures are a part of syndesmotic lesions. Therefore, in theory, a Maisonneuve fracture is unstable, since both columns are affected ( 9). But if it is ruptured on 2 places, it becomes unstable. If the ring is ruptured on one place, which means that only one column is broken, the joint remains stable. Some authors consider the ankle as a ring where the bone and ligament structures contribute to its stability. The ankle joint can be considered as 2 columns: medial and lateral. Posterior tibiofibular ligament (PTFL) may be intact, resulting in partial diastasis of the mortise ( 8). Lesions most frequently associated with Maisonneuve fractures are the interosseous and anterior inferior tibiofibular ligaments (AITFL), the posterior malleolus, the deltoid ligament and the medial malleolus ( 7). Disruption of the interosseous membrane (IOM) usually progresses to the neck of the fibula with a concomitant spiral fracture. The force is then transmitted anteriorly, with the talus acting as a wedge, resulting in rupture of the anterior tibiofibular and interosseous ligaments. The sequence of the injury is described as follows: the talus performs an external rotation and creates a strain on the medial column of the mortise. The main injury mechanism proposed is an external rotation of a pronated and fixed foot ( 1). It is frequently a sport-related injury, occurring in a relatively young population ( 4- 6). Diagnosis is often overlooked and probably occurs more often than assumed among ankle fractures, Maisonneuve fractures accounting for 0.7% to 10% in some studies ( 2- 4). It was originally described by the French surgeon Jules Germain François Maisonneuve in 1840 ( 1). We performed closed reduction easily by reverse the mechanism of injury.Maisonneuve fractures are characterised by a pattern of the following lesions: a medial malleolar fracture or deltoid ligament rupture, a disruption of the ankle syndesmosis ligaments and a fracture of the proximal fibula. The mechanism of the injury is a twisting motion of the upperbody inward, while the foot is planted, resulting a more higher energy impacted to the ankle and fibula. T he pattern of the fracture-dislocation of the ankle discussed is very rare. Normal range of motion is achieved well after 8 weeks, without pain on full weightbearing. We performed operation which are consists of three procedures closed reduction, percutaneous fixation of syndesmotic by using a single transfixing screw, and plate-screw for the fibula. On imaging, plain radiographs of left ankle showed dislocation of the ankle, with disruption of syndesmotic and fracture comminutive middle third of fibula. Physical examination showed deformity, swelling and tenderness on his left ankle. A 19 year old male presented to us with pain and swelling of his left ankle after felt while playing futsal. The mechanism for the fracture is an external rotation force to the ankle with transmission of the force through the interosseous membrane which causes a proximal fibular fracture.In a very rare form, we can found an unusual pattern of the level of the involved fibula, such as middle third of fibula. Abstract: A Maisonneuve’s Fracture is a fracture of proximal third fibula associated with a disruption of the distal tibiofibular syndesmosis, the interosseous membrane and associated injuries (eg, fracture of the medial malleolus, fracture of the posterior malleolus, and rupture of the deltoid ligament).
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