A Woman With Ankle Pain

Article Outline

• Diagnosis
  • Maisonneuve Fracture
• References
• Copyright

[Ann Emerg Med. 2010;56:94.]

A 40-year-old woman presented to the emergency department (ED), complaining of severe left ankle pain. She stated that just before arrival, she twisted her ankle and then fell to the ground. She had no medical history and had no previous injuries to the affected ankle. On physical examination, she had a significant amount of swelling around her ankle. She had tenderness to palpation over her medial malleolus (Figure 1), as well as her proximal fibula (Figure 2). Radiographs were performed in the ED. (Figure 1, Figure 2, Figure 3).

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• Figure 1. 

  Medial malleolus fracture with widening of the anterior syndesmosis and medial clear space.³, ⁴

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• Figure 2. 

  Proximal fibular spiral fracture.

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• Figure 3. 

  Status post–open reduction and internal fixation.

Used with permission of Anna L. Waterbrook, MD, Department of Emergency Medicine, University of Arizona, Tucson, AZ.

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Diagnosis 

Maisonneuve Fracture 

This fracture is an unstable ankle injury that consists of a proximal fibula fracture with an associated injury to the medial malleolus, deltoid ligament, or tibiofibular syndesmosis.¹ It is caused by eversion of the ankle. As the talus everts, it places stress on the medial portion of the ankle and affects the fibula transmitting forces through the interosseous membrane to the proximal fibula.¹ When there is injury to the medial malleolus, the proximal fibula should also always be evaluated because patients may not initially complain of pain in this area.² These unstable ankle injuries usually require open reduction and internal fixation.

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References 

1. Sproule JA, Khalid M, O'Sullivan M, et al. Outcome after surgery for Maisonneuve fracture of the fibula. Injury. 2004;35:791–798
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2. Kane SF. Ankle fractures. In:  Seidenberg PH,  Beutler AI editor. The Sports Medicine Resource Manual. Philadelphia, PA: Saunders Elsevier; 2008;p. 364–365
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3. Duke Orthopaedics. Ankle Frx: medial clear space vs lateral talar shift. [Wheeless' Textbook of Orthopaedics Web site] http://www.wheelessonline.com/ortho/ankle_frx_medial_clear_space_vs_lateral_talar_shiftAccessed July 18, 2009
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4. Duke Orthopaedics. Objective diagnosis of syndesmotic injury. [Wheeless' Textbook of Orthopaedics Web site] http://www.wheelessonline.com/ortho/objective_diagnosis_of_syndesmotic_injuryAccessed July 18, 2009
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