Maisonneuve Fracture

History: ? Medial Mal Fx

EMR History: Slip on ice. Unable to ambulate.

Success! Change the ? to a + and we're done....(insert picture of George W. Bush in front of "Mission Accomplished" banner)

Buuuuttt spaces seem widened, right? 

Medial clear space should be equal to the tibiotalar joint space, usually less than 4 mm. Anything over 6 mm requires disruption of the medial supporting ligaments....

Lateral clear space which represents the syndesmosis ligament integrity also looks wide.  Should be less than 6 mm when measured 1 cm above the joint. 

Abnormal....and the posterior mal is fractured too!

But with all this widening and the medial and posterior mal fractures, why isn't the lateral malleolus fractured?  Seems like we've cooked up most of the ingredients of a Weber C type / PER mechanism…

Source: https://radiologyassistant.nl/musculoskeletal/ankle/weber-and-lauge-hansen-classification

So we skipped the typical 3rd step, where's the fracture?

(whispers) get the tib fib film....

Not all Weber C injuries occur in the typical FOV of an Ankle series.  When they occur at the proximal fibula, people like to get fancy and refer to it as a Maisonneuve Fracture. 

Think about the lateral widening force distally and the relative inelastic nature of the proximal tib-fib connection, you'd expect the fracture to occur somewhere along the length of the fibula.   Like a wishbone, but it's human leg bones instead. 

Teaching Point:

• If you don't see a lateral malleolus fracture when there is medial side avulsion injury and widening of the distal syndesmosis, recommend the tib fib film series.
• Maisonneuve Fracture is just eponymous fancy French talk for Weber C / PER injury with a high fibular fracture. 

https://radiopaedia.org/articles/maisonneuve-fracture?lang=us