Maisonneuve Fracture

1. Ankle Case # 2

2. 18 yo WF pw ankle pain. While walking, she stumbled across an exposed root and twisted her ankle and fell. She reports pain in her ankle and says the inside of her ankle looks weird. Pain is 10/10 but she denies all other pain including pain in her head, neck, back and contralateral lower extremity. History and Physical T 99.6 P 112 BP 126/84 O2 97% Gen: Obvious discomfort 2/2 pain. CV: Tachycardic , no m/r/g Pulm : CTAB. MSK: Left ankle with obvious bony abnormality at med mal. NV intact. Decreased ROM, active and passive at L ankle. TTP at proximal fibula ( ipsilateral ).

3. Image

4. Diagnosis: Maisonneuve Fracture

5. Elevate and Ice Foot Analgesics Reduce if possible If stable, immobilize – long leg cast, non weight bearing, crutches f/u with orthopedics in Follow up with Orthopedics in 1 week If unstable, immobilize, emergent ortho consult ED Management

6. This fracture includes proximal fracture of fibula, avulsion fracture of medial malleolus , and syndesmosis disruption. Typically does poorly with conservative treatment so prepare patient for high likelihood of internal fixation. Similar to Galeazi and Monteggia fractures. Anticipate this in someone c/o ankle pain. Make sure to palpate the entire tibia and fibula. Pearls

7. Additional Images

8. Tintinalli's Emergency Medicine: A Comprehensive Study Guide . O. John Ma, M.D., Judith E. Tintinalli , J. Stephan Stapczynski , David M. Cline. McGraw-Hill Professional Publishing: 2010. Wheeless Textbook of Orthopedics . Clifford R Wheeless , MD. Evidence-based treatment of maisonneuve fractures . Stufkens SA, van den Bekerom MP, Doornberg JN, van Dijk CN, Kloen P. J Foot Ankle Surg. 2011 Jan-Feb;50(1):62-7. Maisonneuve fracture . Millen JC, Lindberg D. J Emerg Med. 2011 Jul;41(1):77-8 References