Surgical Treatment of Maisonneuve Fractures

Abstract

Objective:

Closed or open reduction and internal fixation of Maisonneuve fracture with the goal to restore form and function of ankle joint. Prevention of posttraumatic osteoarthritis.

Indications:

Proximal fibular fractures associated with rupture of the distal tibiofibular syndesmosis, the interosseous membrane, and the deltoid ligament; sometimes associated with fracture of the medial malleolus and the posterior rim of the tibia.

Contraindications:

Poor skin and soft-tissue conditions. Poor general health.

Surgical Technique:

Open or closed reduction and repositioning of lateral malleolus into fibular incisure of the tibia. Internal fixation with one or two temporarily inserted syndesmosis screws. Suture of syndesmosis. Treatment of associated injuries.

Postoperative Management:

Split below-knee cast. After wound healing closed below-knee cast for 6 weeks and walking with crutches and partial weight bearing. Removal of syndesmosis screw(s) 6–8 weeks postoperatively. Once ligamentous stability has been ascertained, increasing mobilization and weight bearing.

Results:

An exact diagnosis, meticulous reduction and internal fixation as well as intensive postoperative physiotherapy will guarantee a satisfactory functional result.