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“Double Maisonneuve fracture”: an unknown fracture pattern

Abstract

Purpose

The aim of this study was to describe pathoanatomy and to raise awareness of a fracture of the lateral malleolus combined with a high subcapital fracture of the fibula caused by a dislocation mechanism.

Methods

The study comprised 11 patients, 5 men and 6 women, with the mean age of 57 years (range, 21–87), with a “Double Maisonneuve fracture”. Individual lesions of ankle structures were described on the basis of radiographs, CT, and intraoperative findings.

Results

The distal fibular fracture was classified as Weber type B in 1 case and Weber type C in 10 cases. The proximal fibular fracture was described as a subcapital oblique spiral fracture with metadiaphyseal involvement in nine cases and a high short oblique fracture with fibular head involvement in two cases. Injury to the deltoid ligament was revealed in six cases; a bicollicular fracture of the medial malleolus was found in five patients. Posterior malleolar fractures were classified as type 1 in eight cases and type 2 in three cases. Avulsion of the Chaput tubercle was detected in four cases. Injury to the interosseous tibiofibular ligament was assessed in nine patients.

Conclusion

Double Maisonneuve fracture is a rare but probably underreported injury that must be taken into consideration during examination, as it may be easily overlooked. The essential part of diagnosis is a careful clinical examination and radiological assessment of the lower leg with additional CT examination of the ankle.

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Acknowledgements

The authors wish to thank Ludmila Bébarová PhD for their assistance in the editing of the manuscript.

Funding

Supported by IP DZRVO MO1012.

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Correspondence to Michal Tuček.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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

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Kašper, Š., Bartoníček, J., Rammelt, S. et al. “Double Maisonneuve fracture”: an unknown fracture pattern. Eur J Trauma Emerg Surg (2021). https://doi.org/10.1007/s00068-021-01786-x

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Keywords

  • Maisonneuve fracture
  • Ankle fractures
  • Posterior malleolus
  • Anterior malleolus
  • Trimalleolar fractures
  • Tibiofibular syndesmosis