The proximal fibula should be examined in all patients with ankle injury: a case series of missed maisonneuve fractures.

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Abstract

[Indexed for MEDLINE] 19. Medicina (Kaunas). 2023 Mar 25;59(4):652. doi: 10.3390/medicina59040652. Anatomical Augmentation Using Suture Tape for Acute Syndesmotic Injury in Maisonneuve Fracture: A Case Report. Yoon SJ(1), Jung KJ(1), Hong YC(1), Yeo ED(2), Lee HS(3), Won SH(4), Lee BR(1), Ji JY(5), Lee DW(6), Kim WJ(1). Author information: (1)Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea. (2)Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea. (3)Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, 68, Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Republic of Korea. (4)Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea. (5)Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea. (6)Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea. Ankle syndesmosis is crucial to the integrity of the ankle joint and weight-bearing; an injury to this structure can lead to significant disability. The treatment methods for distal syndesmosis injuries are controversial. The representative treatment methods include transsyndesmotic screw fixation and suture-button fixation, and good results with suture tape augmentation have recently been reported. However, an augmentation using suture tape is only possible when the posterior inferior tibiofibular ligament (PITFL) is intact. This study describes the case of an unstable syndesmosis injury, accompanied by anterior inferior tibiofibular ligament (AITFL) and PITFL injuries, which were treated successfully using suture tape. A 39-year-old male patient sustained right ankle damage while skateboarding. His leg and ankle radiographs revealed a widening of the medial clear space, a posterior malleolus fracture, a reduced "syndesmosis overlap" compared with the contralateral side, and a proximal fibula fracture. The magnetic resonance imaging revealed ruptured deltoid ligaments, accompanied by AITFL, PITFL, and interosseous ligament injuries. A diagnosis of a Maisonneuve fracture with an unstable syndesmotic injury was made. The patient underwent an open syndesmotic joint reduction, along with an AITFL and PITFL augmentation. This anatomical reduction was confirmed using intraoperative arthroscopy and postoperative computed tomography (CT). An axial CT that was performed at the 6-month follow-up exam revealed a similar alignment of the syndesmosis between the injured and uninjured sides. There were no surgical complications and the patient did not complain of discomfort in his daily life. At the 12-month follow-up exam, a good clinical outcome was confirmed. As a treatment for unstable syndesmosis injury, ligament augmentation using suture tape shows satisfactory clinical outcomes and can be considered as a useful and reliable method for anatomical restoration and rapid rehabilitation. DOI: 10.3390/medicina59040652 PMCID: PMC10145241