The Maisonneuve fracture associated with a Weber B fracture

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Journalof the International Foot & Ankle Foundation


Maisonneuve fractures are defined as a fracture of the proximal fibula associated with an injury to the ankle ligaments or a fracture of the medial malleolus. According to the Lauge-Hansen classification system the mechanism of injury is pronation-external rotation (PER). The Danis-Weber classification system is based on the level of the fracture in relation to the syndesmosis and the ankle joint. A Weber B fracture is defined as an oblique fracture at the level of the ankle joint. A 62-year-old female presented to the emergency department for evaluation of her left ankle following an injury. The patient stated that she fell from a height of approximately 5 feet while at home impacting and twisting her ankle. Radiographs of the left ankle demonstrated an oblique fracture through the lateral malleolus consistent with a Weber B fracture with minimal displacement and mild increased widening of medial clear space. Radiographs of the left leg also demonstrated minimally displaced Maisonneuve fracture. Computerized tomography (CT) of the left ankle demonstrated minimally displaced obliquely oriented fracture of the distal fibula, a small avulsion fracture of the anterior tibial insertion of the tibiofibular ligament and on the posterior tibial insertion of the tibiofibular ligament, as well as mild widening of the medial clear space. The patient underwent surgery consisting of open reduction and internal fixation of the lateral malleolus with syndesmotic reduction of her left ankle. It is rare to see a distal and proximal fibular fracture injury occurring simultaneously. The proximal aspect of the fibula should always be examined as part of the physical exam in all ankle fractures to obtain an accurate diagnosis and to provide an appropriate treatment.





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