Description
A healthy, 41-year-old man sustained a left ankle injury, resulting in persistent pain that was initially diagnosed as an ankle sprain without radiographic abnormalities. Further examination at our hospital showed medial malleolus and left proximal fibula tenderness; pain on manual compression of the proximal tibia and fibula suggested tibiofibular syndesmosis injuries. Plain, full-length tibial and fibular radiography revealed an oblique fracture through the proximal diaphysis of the left fibula (figure 1). Maisonneuve fracture typically involves deltoid ligament rupture, tibiofibular ligament disruption and a spiral fracture of the proximal fibula.1 Syndesmosis injuries involve multiple ligaments between the distal tibia and fibula; restoring their association is key to effective treatment.2 Because delayed surgical intervention prolongs ankle pain, open reduction and internal fixation are generally performed.3 This patient underwent suture button fixation of tibiofibular syndesmosis (figure 2). He returned to work without complications 3 months after surgery.
Figure 1.
Left tibia-fibula anterior-posterior X-ray showed proximal fibula spiral fracture (arrow).
Figure 2.
X-ray showed suture button fixation of tibiofibular syndesmosis.
Learning points.
Patient with ankle injuries should examine proximal fibula tenderness.
Maisonneuve fracture is unstable injuries and require the patient to consult an orthopaedic surgeon.
Footnotes
Contributors: YJ, KI and MT contributed to patient management. RI drafted the initial manuscript. MT critically reviewed manuscript. All authors contributed to writing the manuscript and have provided written consent for publication.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: None declared.
Patient consent for publication: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.
References
- 1.Smeeing DPJ, Houwert RM, Kruyt MC, et al. The isolated posterior malleolar fracture and syndesmotic instability: a case report and review of the literature. Int J Surg Case Rep 2017;41:360–5. 10.1016/j.ijscr.2017.10.062 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Taweel NR, Raikin SM, Karanjia HN, et al. The proximal fibula should be examined in all patients with ankle injury: a case series of missed maisonneuve fractures. J Emerg Med 2013;44:e251–5. 10.1016/j.jemermed.2012.09.016 [DOI] [PubMed] [Google Scholar]
- 3.Richmond RR, Henebry AD. A Maisonneuve fracture in an active duty sailor: a case report. Mil Med 2018;183:e278–80. 10.1093/milmed/usx080 [DOI] [PubMed] [Google Scholar]