This patient presented to the ED after twisting their ankle playing basketball. Notably on clinical exam the patient also had pain to palpation near the proximal lower leg:
These radiographs show two clearly visible fractures on the proximal and distal fibula. Also noted is some widening of the mortis on gravity stress view and if you look closely on the anterior tib/fib image (top) there is a comminuted proximal tibia fracture. The injury pattern seen here is an example of a Maisonneuve type fracture.
A Maisonneuve fracture occurs when with disruption of the distal tibiofibular syndesmosis is associated with a proximal fibular fracture. Often a medial malleolar fracture will be seen as well (not in this image). This is an unstable fracture pattern that often needs operative intervention. This image has an additional proximal tibia fracture that isn’t usually classic for a Maisonneuve fracture pattern.
In order not to miss this fracture one should always perform a proximal lower leg exam with all ankle injuries! Image the entire fibula if there is pain.
Author: Russell Jones, MD