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Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination

  • Jan Bartoníček
  • Stefan Rammelt
  • Štěpán Kašper
  • Jozef Malík
  • Michal Tuček
Trauma Surgery
  • 61 Downloads

Abstract

Introduction

Although Maisonneuve fracture (MF) is a well-known type of ankle fracture–dislocation, there is still a lack of information about the epidemiology and the extent of all associated injuries. The aim of study is to describe MF pathoanatomy on the basis of radiographs, CT scans and intraoperative findings.

Materials and methods

The study comprised 54 adult patients. MF was defined as an ankle fracture–dislocation with a fracture of the fibula in its proximal quarter. Ankle radiographs and lower leg radiographs were obtained in all patients. Computed tomography (CT) examination was performed in 43 patients, of these in 34 patients in combination with 3D CT reconstructions. A total of 51 patients were treated operatively, and in 38 of these an open procedure was performed.

Results

The fibular fracture—fibular head was involved in four cases, and the subcapital region of the proximal quarter of the fibula was affected in 50 cases. Fractures of the posterior malleolus were identified in 43 of 54 patients (80%). Injury to the deltoid ligament was recorded in 27 cases (50%), a fracture of the medial malleolus in 20 cases (37%) and medial structures were intact in 7 cases (13%). Position fibula in fibular notch—in 9 cases the position changed only minimally, in 11 cases the space between the tibia and the fibula was larger than 2 mm, in 20 cases widening of the tibiofibular space was associated with external rotation of the fibula, in 2 cases fibula was trapped behind the posterior tibial tubercle and in 1 case it was associated with a complete tibiofibular diastasis.

Conclusion

MF is a variable injury, always associated with rupture of the anterior and interosseous tibiofibular ligaments. CT examination should be employed widely in MF, and MRI should be considered under special circumstances.

Keywords

Ankle fracture Maisonneuve fracture Posterior malleolar fracture Deltoid ligament injury 

Notes

Acknowledgements

This study was approved by the Institutional Ethics Committee. The authors wish to thank Prof. Chris Colton, MD, FRCS and Ludmila Bébarová for their assistance in the preparation of the manuscript.

Funding

This study was funded by grant of AZV-CR (Czech Agency for the Medical Research) Agentura pro zdravotnický výzkum České republiky 16-28458A: Trimalleolar ankle fractures - CT diagnostics of fractures of posterior tibial rim, their CT classification and operative treatment.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jan Bartoníček
    • 1
  • Stefan Rammelt
    • 2
  • Štěpán Kašper
    • 1
  • Jozef Malík
    • 3
  • Michal Tuček
    • 1
  1. 1.Department of Orthopaedics, First Faculty of MedicineCharles University and Military University Hospital PraguePrague 6Czech Republic
  2. 2.University Center of Orthopedics and TraumatologyUniversity Hospital Carl Gustav Carus DresdenDresdenGermany
  3. 3.Department of RadiologyMilitary University Hospital PraguePrague 6Czech Republic

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