Maisonneuve fracture: Difference between revisions
No edit summary |
|||
(35 intermediate revisions by 10 users not shown) | |||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
* | *Lower extremity equivalent of [[Galeazzi fracture]] | ||
== | ===Components=== | ||
* | *Fibula fracture (anywhere from head or as far down as 6cm above ankle joint) | ||
*Deltoid ligament rupture or medial malleolus avulsion fracture | |||
*Injury then directed upward and laterally tearing interosseous membrane and anterior inferior tibiofibular ligament | |||
*May involve posterior tibiofibular ligament or posterior malleolar fracture | |||
== | ==Clinical Features== | ||
* | *Results from external rotation force applied to foot | ||
== | ==Differential Diagnosis== | ||
{{Distal leg fractures DDX}} | |||
==Evaluation== | |||
*Assess distal pulse, motor, and sensation | |||
*Inspect skin for signs of open fracture | |||
*Long leg film that includes ankle | |||
**Increase in medial clear space of ankle joint | |||
**Tibiofibular clear space widened >5mm | |||
**High fibular fracture | |||
*Signs of[[Ankle syndesmosis injury| syndesmotic injury]] | |||
[[File:Maisonneuve fracture.jpg|thumb|Maisonneuve fracture]] | |||
==Management== | |||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*[[Long leg posterior splint]] with reduction of medial ankle and syndesmotic clear space | |||
==Disposition== | |||
''Depends on degree of associated ankle injury'' | |||
*If splinted and stabilized, can be discharged after consultation with ortho<ref>J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. PMID: 17548882</ref> | |||
**Will need close follow-up for likely operative repair | |||
*Admit for:<ref>J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. PMID: 17548882</ref> | |||
**[[Open fracture]] | |||
**Signs of neurovascular injury | |||
**Concern for [[compartment syndrome]] | |||
===Specialty Management=== | |||
*Usually requires surgical intervention (syndesmotic screws; proximal fibular fracture usually requires no fixation) | |||
==See Also== | |||
*[[Ankle syndesmosis injury]] | |||
*[[Distal leg fractures]] | |||
==References== | |||
<references/> | |||
[[Category: | [[Category:Orthopedics]] |
Revision as of 04:59, 18 September 2019
Background
- Lower extremity equivalent of Galeazzi fracture
Components
- Fibula fracture (anywhere from head or as far down as 6cm above ankle joint)
- Deltoid ligament rupture or medial malleolus avulsion fracture
- Injury then directed upward and laterally tearing interosseous membrane and anterior inferior tibiofibular ligament
- May involve posterior tibiofibular ligament or posterior malleolar fracture
Clinical Features
- Results from external rotation force applied to foot
Differential Diagnosis
Distal Leg Fracture Types
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- Foot and toe fractures
Evaluation
- Assess distal pulse, motor, and sensation
- Inspect skin for signs of open fracture
- Long leg film that includes ankle
- Increase in medial clear space of ankle joint
- Tibiofibular clear space widened >5mm
- High fibular fracture
- Signs of syndesmotic injury
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Long leg posterior splint with reduction of medial ankle and syndesmotic clear space
Disposition
Depends on degree of associated ankle injury
- If splinted and stabilized, can be discharged after consultation with ortho[1]
- Will need close follow-up for likely operative repair
- Admit for:[2]
- Open fracture
- Signs of neurovascular injury
- Concern for compartment syndrome
Specialty Management
- Usually requires surgical intervention (syndesmotic screws; proximal fibular fracture usually requires no fixation)