A Maisonneuve fracture is a spiral proximal fibular fracture associated with an ankle joint injury and represents a pronation-external rotation injury that results a medial injury (medial malleolar avulsion or deltoid ligament tear), a posterior injury (posterior malleolar fracture or posterior tibiofibular ligament tear), and a tear of the anterior tibiofibular ligament and interosseous membrane to the level of the fibular fracture.
A Maisonneuve fracture should be suspected whenever there is lateral talar displacement or tibiofibular widening without a distal fibular fracture or in the case of an "isolated" posterior malleolar fracture.
The patient in the above case has some soft tissue swelling medially in the first panel. Stress views (medial panel) show widening of the medial clear space (i.e., lateral talar dsiplacement). A frontal radiograph of the tibia and fibula reveals a fracture of the proximal-to-mid fibula.
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