Maisonneuve Fracture

Figure 1: AP and lateral ankle radiographs demonstrate a vertical fracture of the medial/posterior malleolus of the distal tibia without a fibular fracture.  

Figure 2: Full-length AP fibular radiograph shows a mildly displaced fracture of the fibular shaft at the junction between the proximal 1/3 and middle 1/3. 

Facts: Rotational Ankle Fractures

• Rotational ankle fractures are classified according to force direction applied to the foot, while the injured foot can be in a different position (supination/pronation, adduction/external rotation)
• AO/Weber classification: A, B, C fractures are differentiated by location of fibular fractures. 
• Fibular fracture below the syndesmosis = AO/Weber A (usually supination-adduction)
• Fibular fracture at the syndesmosis = AO/Weber B (~ supination and external rotation)
• Fibular fracture above the syndesmosis = AO/Weber C (~ pronation external rotation)

Facts: Maisonneuve Fractures

• High fibular fracture above the syndesmosis resulting from external rotation
• Often, there is injury to the medial ankle either a tranverse medial malleolar fracture, posterior malleolar fracture or disruption of the deltoid ligament
• Disruption of the syndesmosis and interosseous ligament up to the fibular fracture site
• Suspicious for this fracture if you see a 1) transverse medial malleolar fracture or 2) posterior malleolar fracture but no fibular fracture on the ankle radiographic series. In these situation, a full-length fibular radiograph should be taken

Reference:

Sakthivel-Wainford K. Self-assessment in limb x-ray interpretation, 2006

Rockwood CA, Green DP. Rockwood and Green's fractures in adults, 2005