Maisonneuve Injury: Beware of the ‘Isolated’ Medial Malleolus or Proximal Fibula Fracture

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Abstract

Ankle injuries are a common presentation of patients to the emergency department. When fractures are noted around the ankle, it is mandatory that the entire leg and knee are examined. We present three cases of patients who attended our emergency department with ankle injuries. Each patient was diagnosed with isolated malleolar fractures and discharged to the fracture clinic. On review by the orthopaedic team, they were all found to have associated proximal fibula fractures, the Maisonneuve injury, which required surgical intervention. Maisonneuve type injuries are easily overlooked in busy emergency departments. Full clinical examination of the entire limb is mandatory and suspicion should be raised if there is (a) tenderness on palpation of the proximal fibula; (b) evidence of talar shift within the joint; (c) isolated malleolar or fibula fractures.