Case Reports   |    
Maisonneuve Fracture Equivalent with Proximal Tibiofibular DislocationA Case Report and Literature Review
B.A. Levy, MD1; K.J. Vogt, DPM1; D.A. Herrera, MD1; P.A. Cole, MD1
1 Regions Hospital, 640 Jackson Street, MS 11503L, St. Paul, MN 55101-2595. E-mail address for B.A. Levy: balevy@umn.edu
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the University of Minnesota, Minneapolis, Minnesota

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 May 01;88(5):1111-1116. doi: 10.2106/JBJS.E.00954
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


The Maisonneuve fracture was initially described in 1840 by Dr. Jacques Maisonneuve1. The initial description involved a proximal fibular fracture associated with an injury to the medial ankle structures. Lauge-Hansen then classified this fracture as a pronation-external rotation variant, with disruption of the syndesmosis2. Danis3 and Weber4 classified these injuries as type-C fractures, and the AO/ASIF Group described them as type-C3 injuries5.This pronation-external rotation mechanism involves either an avulsion fracture of the medial malleolus or disruption of the deltoid ligaments. This is followed by an external rotation force that causes disruption of the syndesmotic ligaments and the interosseous membrane. The energy pattern continues along the path of the interosseous membrane and exits in the proximal fibular region. Proximal tibiofibular dislocation initially was described by Dubreuil6 in 1844 and then by Malgaigne in 18557.
Figures in this Article

    First Page Preview

    View Large
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Bruce A. Levy, M.D.
    Posted on June 09, 2006
    Dr. Levy and colleagues respond to Dr. Kumar
    Vice Chief of Orthopaedic Surgery, Regions Hospital. Assistant Professor, University of Minnesota

    We thank Dr. Kumar very much for his comments regarding our case report and literature review. We apologize for not citing his article, "Superior Tibiofibular Joint Disruption as a Variant of Maisonneuve Injury." We feel that his points are valid, and agree that the sooner any joint is reduced, the higher the chances of success with closed reduction.

    Having said that, in our case the joint was reduced manually but the reduction was unable to be maintained. As it turns out, it was buttonholed through the capsule. Therefore, even if the injury would have been recognized sooner, we do not feel closed reduction would have been successful.

    We agree with Dr. Kumar as well that optimum management for this rare injury pattern is unknown at the present time.

    Gunasekaran Kumar
    Posted on May 19, 2006
    Treatment of Maisonneuve Fracture Equivalent With Proximal Tibio-Fibular Dislocation
    Worthing Hospital, UK

    To the Editor:

    In their article ‘Maisonneuve Fracture Equivalent with Proximal Tibio fibular Dislocation. A Case Report and Literature Review.’(1), Levy et al have provided an in depth discussion about this unusual injury. We speculate that one of the reasons for the need of open reduction in their patient could have been the delay to surgery (10 days).

    In their literature review the authors did not cite the article – ‘Superior tibiofibular joint disruption—as a variant of Maisonneuve injury.’ by G Kumar, et al(2). In that case report we described a similar injury. The disruption to the ankle mortise was clearly seen in the ankle radiograph and did not require a stress view. MRI scan of the knee in our case did not show any pathology. Closed reduction was performed in less than 24 hours from the time of injury. The superior tibio fibular joint remained stable. Hence, only the distal tibio fibular joint was stabilised with two lag screws (involving all four cortices) which were removed at 3 months post surgery.

    As pointed out by the authors this injury is unusual and, hence, limited evidence is available on its optimal management. A high degree of suspicion is essential to diagnose this injury. Our view is that as with any joint dislocation, the sooner the joint is reduced the higher the chances of success with closed reduction.


    1. B.A. Levy, K.J. Vogt, D.A. Herrera, and P.A. Cole. Maisonneuve Fracture Equivalent with Proximal Tibiofibular Dislocation. A Case Report and Literature Review. J Bone Joint Surg Am 2006; 88: 1111-1116.

    2. G. Kumar, B. Sankar, S. Anand and S. R. Murali. Superior tibiofibular joint disruption - as a variant of Maisonneuve injury. Foot and Ankle Surgery 2004; 10(1): 41-43.

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    Georgia - Choice Care Occupational Medicine & Orthopaedics
    Ohio - OhioHealth Research and Innovation Institute (OHRI)