$maisonneuve fracture$

$maisonneuve fracture$

Information from this report should provide a useful reference for physicians who treat these injuries. The purpose of this study was to describe for the first time the outcomes of two patients with Maisonneuve fracture injuries associated with an avulsion fracture of the PITFL and an intact deltoid ligament, treated successfully by conservative therapy with an early weight bearing protocol. Literature does not establish well-defined criteria for the decision of conservative treatment for Maisonneuve fractures. ( 19) published a case report of conservative treatment of a Maisonneuve fracture with integrity of the deltoid ligament, and with a non-weight bearing protocol. The last comparison study was published in 1998 and found better outcomes in the operative group ( 18). Outcomes of conservative treatment are rarely described in the literature. However, posterior syndesmotic injury in the form of tibial avulsion fracture of the posterior inferior tibiofibular ligament (PITFL) (considered equivalent to a posterior malleolus fracture) was not considered in these studies, nor was the role of the medial column. Nevertheless, some authors recommend conservative treatment for certain type of Maisonneuve fractures in case of partial disruption of the syndesmosis, in the absence of diastasis, or in the absence of ligament or bone lesion of the medial malleolus ( 8, 17). However, in most studies about the management of a Maisonneuve fracture, surgical stabilization of the syndesmosis is the first choice regardless of syndesmotic stability ( 16). According to two recent meta-analyses, there is, to date, insufficient evidence to say which modality is the best to treat an ankle fracture considered unstable ( 14, 15). Surgical or conservative methods are employed to allow the joint to heal in this sense. It is admitted that a syndesmosis lesion may be associated with a significant instability of the joint, which could lead to osteoarthritis if not adequately stabilized ( 13).įor ankle fractures in general, it is recognized that restoring anatomical congruence to the ankle joint is important to improve function and decrease post-traumatic osteoarthritis. Syndesmosis lesions reach a consensus in the literature for surgical treatment in case of diastasis of the distal tibiofibular joint or associated fracture around the ankle ( 10- 12). Maisonneuve fractures are a part of syndesmotic lesions. Therefore, in theory, a Maisonneuve fracture is unstable, since both columns are affected ( 9). But if it is ruptured on 2 places, it becomes unstable. If the ring is ruptured on one place, which means that only one column is broken, the joint remains stable. Some authors consider the ankle as a ring where the bone and ligament structures contribute to its stability. The ankle joint can be considered as 2 columns: medial and lateral.

$maisonneuve fracture$

Posterior tibiofibular ligament (PTFL) may be intact, resulting in partial diastasis of the mortise ( 8). Lesions most frequently associated with Maisonneuve fractures are the interosseous and anterior inferior tibiofibular ligaments (AITFL), the posterior malleolus, the deltoid ligament and the medial malleolus ( 7). Disruption of the interosseous membrane (IOM) usually progresses to the neck of the fibula with a concomitant spiral fracture. The force is then transmitted anteriorly, with the talus acting as a wedge, resulting in rupture of the anterior tibiofibular and interosseous ligaments. The sequence of the injury is described as follows: the talus performs an external rotation and creates a strain on the medial column of the mortise. The main injury mechanism proposed is an external rotation of a pronated and fixed foot ( 1). It is frequently a sport-related injury, occurring in a relatively young population ( 4- 6). Diagnosis is often overlooked and probably occurs more often than assumed among ankle fractures, Maisonneuve fractures accounting for 0.7% to 10% in some studies ( 2- 4). It was originally described by the French surgeon Jules Germain François Maisonneuve in 1840 ( 1). Maisonneuve fractures are characterised by a pattern of the following lesions: a medial malleolar fracture or deltoid ligament rupture, a disruption of the ankle syndesmosis ligaments and a fracture of the proximal fibula.

$maisonneuve fracture$