PURPOSE: The aim of this study was to describe pathoanatomy and to raise awareness of a fracture of the lateral malleolus combined with a high subcapital fracture of the fibula caused by a dislocation mechanism. METHODS: The study comprised 11 patients, 5 men and 6 women, with the mean age of 57 years (range, 21-87), with a "Double Maisonneuve fracture". Individual lesions of ankle structures were described on the basis of radiographs, CT, and intraoperative findings. RESULTS: The distal fibular fracture was classified as Weber type B in 1 case and Weber type C in 10 cases. The proximal fibular fracture was described as a subcapital oblique spiral fracture with metadiaphyseal involvement in nine cases and a high short oblique fracture with fibular head involvement in two cases. Injury to the deltoid ligament was revealed in six cases; a bicollicular fracture of the medial malleolus was found in five patients. Posterior malleolar fractures were classified as type 1 in eight cases and type 2 in three cases. Avulsion of the Chaput tubercle was detected in four cases. Injury to the interosseous tibiofibular ligament was assessed in nine patients. CONCLUSION: Double Maisonneuve fracture is a rare but probably underreported injury that must be taken into consideration during examination, as it may be easily overlooked. The essential part of diagnosis is a careful clinical examination and radiological assessment of the lower leg with additional CT examination of the ankle.

Department of Orthopaedics 1st Faculty of Medicine Charles University and Military University Hospital Prague U Vojenské Nemocnice 1200 169 02 Prague 6 Czech Republic

University Center for Orthopaedics Trauma and Plastic Surgery University Hospital Carl Gustav Carus at TU Dresden Fetscherstrasse 74 01307 Dresden Germany

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Maisonneuve JG. Recherches sur la fracture du peroné. Arch Gen Med. 1840;7(165–87):433–73.

Amman E. Die Maisonneuve-Fraktur Resultate von 37 behandelten Fällen in der Jahren 1971–1981. Inauguraldissertation. Universität Basel 1981

Babis GC, Papagelopoulos PJ, Tsarouchas J, Zoubos AB, Korres DS, Nikiforidis P. Operative treatment for Maisonneuve fracture of the proximal fibula. Orthopedics. 2000;23:687–90. DOI

de Souza LJ, Gustilo RB, Meyer TJ. Results of operativetreatment of displaced external rotation-abduction fractures of the ankle. J Bone Joint Surg. 1985;67-A:1066–74. DOI

He JQ, Ma XL, Xin JY, Cao HB, Li N, Sun ZH, Wang GX, Fu X, Zhao B, Hu FK. Pathoanatomy and injury mechanism of typical Maisonneuve fracture. Orthop Surg. 2020;12:1644–51. https://doi.org/10.1111/os.12733 . PubMed DOI PMC

Kirschner P, Brünner M. Die operation der maisonneuve-fraktur. Oper Orthop Traumatol. 1999;11:11–8. DOI

Kolman J. Maisonneuve fracture. Acta Chir Orthop Traumatol Cech. 1999;66:41–5. PubMed

Manyi W, Guowei R, Shengsong Y, Chunyan J. A sample of Chinese literature MRI diagnosis of interosseous membrane injury in Maisonneuve fractures of the fibula. Injury. 2000;31(Suppl3):C107–10. DOI

Merrill KD. The Maisonneuve fracture of the fibula. Clin Orthop Relat Res. 1993;287:218–23. DOI

Pankovich AM. Maisonneuve fracture of the fibula. J Bone Joint Surg. 1976;58-A:337–42. DOI

Pelton K, Thordarson DB, Barnwell J. Open versus closed treatment of the fibulae in Maisonneuve injuries. Foot Ankle Int. 2010;31:604–8. DOI

Sproule JA, Khalid M, O´Sullivan M, McCabe JP, . Outcome after surgery for Maisonneuve fracture of the fibula. Injury. 2004;35:791–8. DOI

Bartoníček J, Rammelt S, Kašper Š, Malík J, Tuček M. Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination. Arch Orthop Trauma Surg. 2019;139:497–506. DOI

Kašper Š, Bartoníček J, Kostlivý K, Malík J, Tuček M. Maisonneuve fracture. Rozhl Chir. 2020;99:77–85. https://doi.org/10.33699/PIS.2020.99.2.77-85 . PubMed DOI

Colenbrander RJ, Struijs PAA, Ultee JM. Bimalleolar ankle fracture with proximal fibular fracture. Arch Orthop Trauma Surg. 2005;125:571–4. DOI

Hensel KS, Harpstrite JK. Maisonneuve fracture associated with a bimalleolar ankle fracture-dislocation: a case report. J Orthop Trauma. 2002;16:525–8. DOI

Slawski DP, West C. Maisonneuve fracture with an associated distal fibular fracture. Clin Orthop Relat Res. 1995;317:193–8.

Wolfram D, Lottersberger C, Blauth M, Piza-Katzer H. Possible nerve injuries in ankle dislocations. Trimalleolar fracture including the proximal fibula. Unfallchirurg. 2007;110:70–4. https://doi.org/10.1007/s00113-006-1183-5 . PubMed DOI

Bartoníček J, Rammelt S, Tuček M, Naňka O. Posterior malleolar fractures of the ankle. Eur J Trauma Emerg Surg. 2015;41:587–600. https://doi.org/10.1007/s00068-015-0560-6 . PubMed DOI

Rammelt S, Bartoníček J, Kroker L, Neumann AP. Surgical fixation of quadrimalleolar fractures of the ankle. J Orthop Trauma. 2021;35:e216–22. https://doi.org/10.1097/BOT.0000000000001915 . PubMed DOI

Tuček M, Rammelt S, Kostlivý K, Bartoníček J. CT controlled results of direct reduction and fixation of posterior malleolus in ankle fractures. Eur J Trauma Emerg Surg. 2021. https://doi.org/10.1007/s00068-020-01309-0 . PubMed DOI

Injury to the posterior malleolus in Maisonneuve fractures

"Double Maisonneuve fracture": an unknown fracture pattern