Maisonneuve fracture: Difference between revisions

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==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
*Results from external rotation force applied to foot
*Leg equivalent of Galeazzi fracture
*3 components:
**1. Fibula fracture (anywhere from head or as far down as 6cm above ankle joint)
**2. Deltoid ligament rupture or medial malleolus fracture
**3. Injury then directed upward and laterally tearing interosseous membrane


==Diagnosis==
==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
*Long leg film that includes ankle
**Increase in medial clear space of ankle joint
**Increase in medial clear space of ankle joint
**Tibiofibular clear space widened >5mm
**Tibiofibular clear space widened >5mm
**High fibular fracture
**High fibular fracture
*Signs of syndesmotic injury
*Signs of[[Ankle syndesmosis injury| syndesmotic injury]]
[[File:Maisonneuve fracture.jpg|thumb|Maisonneuve fracture]]
[[File:Maisonneuve fracture.jpg|thumb|Maisonneuve fracture]]


==Differential Diagnosis==
==Management==
{{Distal leg fractures DDX}}
{{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]]


==Treatment==
===Specialty Management===
*Usually requires surgical intervention
*Usually requires surgical intervention (syndesmotic screws; proximal fibular fracture usually requires no fixation)
*[[Long leg posterior splint]] until further f/u


==See Also==
==See Also==
*[[Ankle syndesmosis injury]]
*[[Distal leg fractures]]
*[[Distal leg fractures]]


==Source==
==References==
*Tintinalli
<references/>


[[Category:Ortho]]
[[Category:Orthopedics]]

Revision as of 04:59, 18 September 2019

Background

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

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
Maisonneuve fracture

Management

General Fracture Management

Specific Management

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]

Specialty Management

  • Usually requires surgical intervention (syndesmotic screws; proximal fibular fracture usually requires no fixation)

See Also

References

  1. J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. PMID: 17548882
  2. J Am Acad Orthop Surg. 2007 Jun;15(6):330-9. PMID: 17548882