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A maisonneuve fracture is a fracture dislocation resulting from external rotational forces to ankle -- through interosseous ligament to fibula.
- Proximal fibula fracture - from external rotational forces (spiral/oblique)
- Ankle components can include any of the following:
- medial maleolus avulsion fx or deltoid ligament rupture
- anterior talofibular ligament rupture
- interosseous ligament rupture
- posterior malleolar fracture
If stability is questionable, orthopedic evaluation under anesthesia is required. Additionally always consider compartment syndrome. Do not rely on Kanduval's signs (pain, paraesthesia, pallor, poikilothermia, pulselessness) - "... with the exception of pain and paraesthesia, these traditional signs are not reliable." Emergent orthopedic consultation and compartment pressure assessment should be performed. (see attached photos)
References
- Maisonneuve Fracture. Wheeless Textbook of Orthopedics. http://www.wheelessonline.com/ortho/maisonneuve_fracture
- Paula, Richard. Compartment Syndrome, Extremity. www.EMedicine.com 2006. http://www.emedicine.com/EMERG/topic739.htm