Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 4, pp 497–506 | Cite as

Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination

  • Jan Bartoníček
  • Stefan Rammelt
  • Štěpán Kašper
  • Jozef Malík
  • Michal TučekEmail author
Trauma Surgery



Although Maisonneuve fracture (MF) is a well-known type of ankle fracture–dislocation, there is still a lack of information about the epidemiology and the extent of all associated injuries. The aim of study is to describe MF pathoanatomy on the basis of radiographs, CT scans and intraoperative findings.

Materials and methods

The study comprised 54 adult patients. MF was defined as an ankle fracture–dislocation with a fracture of the fibula in its proximal quarter. Ankle radiographs and lower leg radiographs were obtained in all patients. Computed tomography (CT) examination was performed in 43 patients, of these in 34 patients in combination with 3D CT reconstructions. A total of 51 patients were treated operatively, and in 38 of these an open procedure was performed.


The fibular fracture—fibular head was involved in four cases, and the subcapital region of the proximal quarter of the fibula was affected in 50 cases. Fractures of the posterior malleolus were identified in 43 of 54 patients (80%). Injury to the deltoid ligament was recorded in 27 cases (50%), a fracture of the medial malleolus in 20 cases (37%) and medial structures were intact in 7 cases (13%). Position fibula in fibular notch—in 9 cases the position changed only minimally, in 11 cases the space between the tibia and the fibula was larger than 2 mm, in 20 cases widening of the tibiofibular space was associated with external rotation of the fibula, in 2 cases fibula was trapped behind the posterior tibial tubercle and in 1 case it was associated with a complete tibiofibular diastasis.


MF is a variable injury, always associated with rupture of the anterior and interosseous tibiofibular ligaments. CT examination should be employed widely in MF, and MRI should be considered under special circumstances.


Ankle fracture Maisonneuve fracture Posterior malleolar fracture Deltoid ligament injury 



This study was approved by the Institutional Ethics Committee. The authors wish to thank Prof. Chris Colton, MD, FRCS and Ludmila Bébarová for their assistance in the preparation of the manuscript.


This study was funded by grant of AZV-CR (Czech Agency for the Medical Research) Agentura pro zdravotnický výzkum České republiky 16-28458A: Trimalleolar ankle fractures - CT diagnostics of fractures of posterior tibial rim, their CT classification and operative treatment.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Maisonneuve JG (1840) Recherches sur la fracture du peroné. Arch Gen Med 7:165–187, 433–473Google Scholar
  2. 2.
    Quenu E (1906) Fracture de Maisonneuve (fracture dite par diastase). Bull Soc Chir (Paris) 32:943–945Google Scholar
  3. 3.
    Chaput VAH (1907) Les fractures malléolaires du cou-de-pied et les accidents du travail. Masson, ParisGoogle Scholar
  4. 4.
    Destot E (1911) Traumatisme du Pied et Rayons X. Masson, ParisGoogle Scholar
  5. 5.
    Tanton J (1916) Fractures en Général: Fractures des Membres Inferiéurs. JB Bailliere, ParisGoogle Scholar
  6. 6.
    Ashhurst APC, Bromer RS (1922) Classification and mechanism of fractures of the leg bones involving the ankle. Arch Surg 4:51–129CrossRefGoogle Scholar
  7. 7.
    Bonnin JG (1950) Injuries to the ankle. Heinemann, LondonGoogle Scholar
  8. 8.
    Weber BG (1966) Die Verletzungen des oberen Sprunggelenkes. Huber, BernGoogle Scholar
  9. 9.
    Pankovich AM (1976) Maisonneuve fracture of the fibula. J Bone Joint Surg 58-A:337–342CrossRefGoogle Scholar
  10. 10.
    Amman E (1981) Die Maisonneuve-Fraktur Resultate von 37 behandelten Fällen in der Jahren 1971–1981. Inauguraldissertation. Universität BaselGoogle Scholar
  11. 11.
    Heim U (1983) Malleolarfrakturen Unfallheilkunde 86:248–258Google Scholar
  12. 12.
    de Souza LJ, Gustilo RB, Meyer TJ (1985) Results of operative treatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg 67-A:1066–1074CrossRefGoogle Scholar
  13. 13.
    Merrill KD (1993) The Maisonneuve fracture of the fibula. Clin Orthop Rel Res 287:218–223Google Scholar
  14. 14.
    Slawski DP, West C (1995) Maisonneuve fracture with an associated distal fibular fracture. Clin Orthop Rel Res 317:193–198Google Scholar
  15. 15.
    Duchesneau S, Fallat LM (1995) The Maisonneuve fracture. J Foot Ankle Surg 34:422–428CrossRefGoogle Scholar
  16. 16.
    Chan D, Jones D (1995) Irreducible syndesmosis due to an entrapped posterior fragment. Injury 26:569–572CrossRefGoogle Scholar
  17. 17.
    Morris JR, Lee J, Thordarson D, Terk M, Brustein M (1996) Magnetic resonance imaging of acute Maisonneuve fractures. Foot Ankle Int 17:259–263CrossRefGoogle Scholar
  18. 18.
    Obeid EMH, Amr M, Hirst P, Paul AS (1998) Percutaneous fixation of Maisonneuve and Maisonneuve-type fractures: a minimally invasive approach. Injury 29:619–622CrossRefGoogle Scholar
  19. 19.
    Kirschner P, Brünner M (1999) Die operation der Maisonneuve-Fraktur. Oper Orthop Traumatol 11:11–18CrossRefGoogle Scholar
  20. 20.
    Kolman J (1999) Maisonneuve fracture. Acta Chir Orthop Traumatol Cech 66:41–45Google Scholar
  21. 21.
    Babis GC, Papagelopoulos PJ, Tsarouchas J, Zoubos AB, Korres DS, Nikiforidis P (2000) Operative treatment for Maisonneuve fracture of the proximal fibula. Orthopedics 23:687–690Google Scholar
  22. 22.
    Manyi W, Guowei R, Shengsong Y, Chunyan J (2000) A sample of Chinese literature MRI diagnosis of interosseous membrane injury in Maisonneuve fractures of the fibula. Injury 31(Suppl 3):C107–C110CrossRefGoogle Scholar
  23. 23.
    Hensel KS, Harpstrite JK (2002) Maisonneuve fracture associated with a bimalleolar ankle fracture-dislocation: a case report. J Orthop Trauma 16:525–528CrossRefGoogle Scholar
  24. 24.
    Sproule JA, Khalid M, O´Sullivan M, McCabe JP (2004) Outcome after surgery for Maisonneuve fracture of the fibula. Injury 35:791–798CrossRefGoogle Scholar
  25. 25.
    Kumar G, Sankar B, Anand S, Murali SR (2004) Superior tibiofibular joint disruption-as a variant of Maisonneuve injury. Foot Ankle Surg 10:41–43CrossRefGoogle Scholar
  26. 26.
    Smith MG, Ferguson E, Kurdy NM (2005) Persistent diastasis in a Maisonneuve fracture -interposition of a tibial osteochondral fragment: a case report. J Foot Ankle Surg 44:225–227CrossRefGoogle Scholar
  27. 27.
    Colenbrander RJ, Struijs PAA, Ultee JM (2005) Bimalleolar ankle fracture with proximal fibular fracture. Arch Orthop Trauma Surg 125:571–574CrossRefGoogle Scholar
  28. 28.
    Levy BA, Vogt KJ, Herrera DA, Cole PA (2006) Maisonneuve fracture equivalent with proximal tibiofibular dislocation. J Bone Joint Surg 86-A:1111–1116CrossRefGoogle Scholar
  29. 29.
    Wolfram D, Lottersberger C, Blauth M, Piza-Katzer H (2007) Mögliche Nervenverletzungen bei Sprunggelenkluxationsverletzungen trimalleoläre Fraktur mit Beteiligung der proximalen Fibula. Unfallchirurg 110:70–74CrossRefGoogle Scholar
  30. 30.
    Yoshimura I, Naito M, Kanazawa K, Takeyama A, Ida T (2008) Arthroscopic findings in Maisonneuve fractures. J Orthop Sci 13:3–6CrossRefGoogle Scholar
  31. 31.
    Hirschmann M, Mauch Ch, Mueller C, Mueller W, Friederich NF (2008) Lateral ankle fracture with missed proximal tibiofibular joint instability (Maisonneuve injury). Knee Surg Sports Traumatol Arthrosc 16:952–956CrossRefGoogle Scholar
  32. 32.
    Madhusudhan TR, Dhana SRM, Smith IC (2008) Report of the case of a rare pattern of Maisonneuve fracture. J Foot Ankle Surgery 47:160–162CrossRefGoogle Scholar
  33. 33.
    Imade SI, Takao M, Miyamoto W, Hishi H, Uchio Y (2009) Leg anterior compartment syndrome following ankle arthroscopy after Maisonneuve fracture. Arthroscopy 25:215–218CrossRefGoogle Scholar
  34. 34.
    Pérez RL, Costa IG (2009) Atypical pattern of Maisonneuve´s fracture-dislocation. Eur J Orthop Surg Traumatol 19:291–295CrossRefGoogle Scholar
  35. 35.
    Pelton K, Thordarson DB, Barnwell J (2010) Open versus closed treatment of the fibulae in Maisonneuve injuries. Foot Ankle Int 31:604–608CrossRefGoogle Scholar
  36. 36.
    Charopoulos I, Kokoroghiannis C, Kragiannis S, Lyritis GP, Papaioannou N (2010) Maisonneuve fracture without deltoid ligament disruption: A rare pattern of injury. J Foot Ankle Surg 49:86e11–86e17CrossRefGoogle Scholar
  37. 37.
    Kalyani BS, Roberts CS, Giannoudis PV (2010) The Maisonnneuve injury: a comprehensive review. Orthopedics 33:190–197CrossRefGoogle Scholar
  38. 38.
    Stufkens SA, van den Bekerom MPJ, Doornberg JN, van Dijk CN, Kloen P (2011) Evidence-based treatment of Maisonneuve fractures. J Foot Ankle Surg 50:62–67CrossRefGoogle Scholar
  39. 39.
    Dienstknecht T, Horst K, Pape H-Ch (2012) A 72-year-old patient with bilateral Maisonneuve fractures. Clin Pract 2:e72 (180–181)CrossRefGoogle Scholar
  40. 40.
    Hings R, Tran WH, Lorich DG (2014) Maisonneuve-Hyperplantarflexion variant ankle fracture. Orthopedics 37:E140–E144Google Scholar
  41. 41.
    Downey MW, Fleming JJ, Elgamil B, Quinn C (2015) Syndesmosis injury with concomitant deltoid disruption in trimalleolar equivalent ankle fracture: a case. Ann Sports Med Res 2:1049 (1–7)Google Scholar
  42. 42.
    van Wessem KJP, Leenen LPH (2016) A rare type of ankle fracture: syndesmotic rupture combined with a high fibular fracture without medical Injury. Injury 47:755–766Google Scholar
  43. 43.
    Bissuel T, Gaillard F, Dagneaux L, Canovas F (2017) Maisonneuve equivalent injury with proximal tibiofibular joint dislocation: case report and literature review. J Foot Ankle Surg 56:404–407CrossRefGoogle Scholar
  44. 44.
    Bartoníček J, Rammelt S, Kostlivý K, Vaněček V, Klika D, Trešl I (2015) Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg 135:506–516Google Scholar
  45. 45.
    Bartoníček J, Džupa V, Frič V, Pacovský V, Skála-Rosenbaum J, Svatoš F (2008) Epidemiology and economic implications of fractures of proximal femur, proximal humerus, distal radius and fracture-dislocation of ankle. Rozhl Chir 87:213–219Google Scholar
  46. 46.
    Jehlička D, Bartoníček J, Svatoš F, Dobiáš J (2002) Fracture-dislocations of the ankle in adults. Part I: Epidemiological evaluation of one-year group of patients. Acta Chir Orthop Tramatol Čech 69:243–247Google Scholar
  47. 47.
    Lauge-Hansen N (1950) Fractures of the ankle II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg 60:957–985CrossRefGoogle Scholar
  48. 48.
    Bartoníček J (2003) Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat 25:379–386CrossRefGoogle Scholar
  49. 49.
    Müller ME, Nazarian S, Koch P et al (1987) The comprehensive classification of long bones. Springer, BerlinGoogle Scholar
  50. 50.
    Bartoníček J, Frič V, Svatoš F, Luňáček L (2007) Bosworth-type fibular entrapment injuries of the ankle—the Bosworth lesion: a report of six cases and literature review. J Orthop Trauma 21:710–717CrossRefGoogle Scholar
  51. 51.
    Bartoníček J, Rammelt S, Kostlivý K (2017) Bosworth fracture: a report of two atypical cases and literature review of 108 cases. FussSprungg 15:126–137CrossRefGoogle Scholar
  52. 52.
    Rammelt S, Zwipp H, Grass R (2008) Injuries to the distal tibiofibular syndesmosis. An evidence-based approach to acute and chronic lesions. Foot Ankle Clin 13:611–633CrossRefGoogle Scholar
  53. 53.
    Takao M, Ochi M, Oae K, Naito K, Uchio Y (2003) Diagnosis of a tear of the tibiofibular syndesmosis. The role of arthroscopy of the ankle. J Bone Joint Surg Br 85-B:324–329CrossRefGoogle Scholar
  54. 54.
    Rammelt S, Boszczyk A (2018) Computed tomography in the diagnosis and treatment of ankle fractures. J Bone Joint Surg Rev 6(12):e1Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jan Bartoníček
    • 1
  • Stefan Rammelt
    • 2
  • Štěpán Kašper
    • 1
  • Jozef Malík
    • 3
  • Michal Tuček
    • 1
    Email author
  1. 1.Department of Orthopaedics, First Faculty of MedicineCharles University and Military University Hospital PraguePrague 6Czech Republic
  2. 2.University Center of Orthopedics and TraumatologyUniversity Hospital Carl Gustav Carus DresdenDresdenGermany
  3. 3.Department of RadiologyMilitary University Hospital PraguePrague 6Czech Republic

Personalised recommendations