Maisonneuve Fracture of the Ankle

A Maisonneuve fracture is a specific type of ankle fracture that occurs when the ankle is forcefully twisted outwards (external rotation). The fracture is important because treatment almost always requires surgery, and without a careful examination of the ankle (and the knee), it's possible to misdiagnose this injury.

The Name

The Maisonneuve fracture was named after a French surgeon named Jules Germain Maisonneuve. Dr. Maisonneuve (pronounced MAY-son-OU-ve) described this injury pattern and its association with injuries that cause a forceful external rotation of the ankle joint. Dr. Maisonneuve was a protege of Dr. Dupuytren, another French surgeon with an important orthopedic eponym for a condition he described.

Today, Dr. Maisonneuve's name is still used to describe this specific injury pattern. While this is an uncommon type of ankle fracture, it is important because without looking carefully, this may appear to be a less serious injury. If not properly diagnosed, there can be long-term problems of the ankle joint, including early ankle arthritis.

Signs

There are several important signs to look for that may indicate an ankle injury could be a Maisonneuve fracture. First, is to understand the mechanism of injury as patients who sustain a Maisonneuve fracture have typically had a very forceful outward twisting of the ankle. This may be a sports injury or may occur from a fall doing normal activities. Other signs of this injury include:

• Pain and swelling around the inner side of the ankle (around the medial malleolus)
• Tenderness around the outer side of the knee (the proximal fibula)
• Aching pain in the calf and shin (syndesmosis injury)

Patients will have X-rays to determine the pattern of injury, and if there is concern that the injury is a Maisonneuve fracture, then X-rays of the knee should also be obtained. In some patients, there is a severe soft-tissue injury that can complicate treatment. The skin should be inspected for fracture blisters and other signs of severe soft-tissue injury.

Causes

A Maisonneuve fracture occurs as a result of a rotational injury of the ankle. Most often, the foot is planted on the ground, and the extremity rotates inward causing strain to occur on the bones and ligaments. When this injury is forceful, it can overcome the strength of the bone and the ligaments. The energy of the injury travels through the ankle joint ligaments adjoining the bones of the leg (the syndesmotic ligament) and out through the fibula bone.

The injury can be difficult to detect because there is often a subtle fracture just below the knee joint, but significant ligament damage is present traveling all the way down to the ankle. This ligament damage can lead to instability of the ankle joint that requires treatment. A normal X-ray of the ankle joint may not show this ligament damage clearly. In order to make the diagnosis, your healthcare provider may need to obtain special X-rays that stress the ankle joint. Within the ankle joint is stressed, the instability will become apparent.

Treatment

Surgical treatment is the standard treatment of a Maisonneuve fracture, although in some patients with no displacement of the fracture or ankle joint, or in poor surgical candidates (elderly or sick patients), nonsurgical treatment could be considered. However, the typical treatment of a Maisonneuve fracture is to perform surgery to restore stability to the ankle joint.

When repairing a Maisonneuve ankle fracture, the medial (inner) side is repaired, and the syndesmosis is repaired. However, the fibula fracture around the knee does not need to be surgically stabilized. The critical structure that needs to be held in position is the syndesmosis (the ligament that connects the shin bones). The syndesmosis is repaired with either screws or very heavy suture material, a few centimeters above the ankle joint.

Rehab From Surgery

Rehab after a Maisonneuve fracture is a several-month process and depends on the severity of the injury, and your surgeon's guidelines. Most surgeons will immobilize the ankle for 4-6 weeks after the surgery, and prevent weight bearing on the extremity for 6-12 weeks following surgery. In addition, some surgeons recommend a second surgery to remove the hardware used to repair the syndesmosis before allowing weight-bearing to resume. This is controversial and can be discussed with your surgeon.

A Word From Verywell

A Maisonneuve fracture is a specific type of injury that involves the ankle joint and extends up the lower extremity. The fracture that occurs with this injury is higher up the leg than the ankle joint although much of the damage to the soft tissues is located around the ankle. Without a careful examination and appropriate imaging studies, this injury can be missed leading to chronic, permanent problems with the ankle joint.