Maisonneuve fracture
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Transcript of Maisonneuve fracture
Extern ConferenceBY CHAWANIN LERSPONGPAIBOOL RAMATHIBODI 5402029
ผปวยหญงไทยค 32 ป ภมลำ�เน� จ.นครร�ชสม� อ.ปกธงชย สทธประกนสขภ�พถวนหน� Chief Complaint : ลมขอเท�ขว�พลก 4 ชม.
PTA
Primary Survey
A : can speak, no cervical tenderness, full ROM of neck
B : clear breath sound both C : BP 133/76 mmHg, full regular pulse 91 bpm,
capillary refill < 2 sec D : E4V5M6 pupil 3 mm RTLBE E : no external wound
Secondary survey A : no drug allergy M : no current medication P : no underlying disease L : last meal 5 hr PTA E : 4 ชม. PTA ผปวยเดนอยบรเวณบ�น เท�ขว�สะดด
กบรองปน ขอเท�บดออกด�นนอก เสยหลกลมลง หลง จ�กนนมอ�ก�รปวดบรเวณขอเท�ขว� ขยบขอเท�ไดเลก
นอย มอ�ก�รปวดม�กขนเมอขยบ ขยบนวเท�ไดปกต เดน ลงนำ�หนกไมได รสกเจบหน�แขงเลกนอย ไมมอ�ก�รช�ท
บรเวณเท� ขยบนวเท�ไดปกต ไมมอ�ก�รเจบบรเวณอน
Physical Examination: Vital signs: BP 133/76 mmHg, PR 91 bpm, T 36.8 C, RR 20 General Appearance: A Thai female, good consciousness, well
co-operative HEENT: not pale, no jaundice Lung: clear, equal breath sound both CVS: normal s1, s2, no murmur Abdomen : soft, tender
Extremities: Right leg
Ottawa ankle rule Bony tenderness at
the distal 6 cm of the posterior edge of the medial malleolus
Bony tenderness at the distal 6 cm of the posterior edge of the lateral malleolus
Inability to bear weight both immediately and in the ED (defined as 4 steps)
(1) underlying neurologic deficit affecting lower limb(s), (2) altered mental status, and (3) multisystem trauma. (4) age < 18 years
Investigation Film right ankle AP, Lateral, Mortise Film right leg AP, lateral
11.69 mm
5.72 mm
Diagnosis Right proximal fibular fracture with right medial malleolus
with distal tibiofibular syndesmosis injury
Maisonneuve injury
Maisonneuve injury Spiral fracture of the upper third
of the fibula with disruption of the distal tibiofibular syndesmosis and associated injuries
eg. fracture of the medial malleolus, fracture of the posterior malleolus, and rupture of the deltoid ligament
Key point! Ankle joint sprain or ankle fracture alone – proximal
fibular is missed.
Proximal fibular fracture alone – ankle injury is missed.
Long leg film that includes the ankle is necessary in case
Patient with proximal fibular fracture to exclude the presence of ankle injury
Unexplained increase in the medial clear space of the ankle joint to diagnose that presence of a high fibular fracture
Syndesmosis rupture Decreased tibiofibular overlap - normal >6 mm on AP view - normal >1 mm on mortise view Increased medial clear space - normal less than or equal to 4 mm Increased tibiofibular clear space - normal <6 mm on both AP and mortise views
Initial Management Check neurovascular (Beware of compartment
syndrome) Immobilize with Posterior long leg slab Leg Elevation Control pain Admit for observation of compartment syndrome Refer for surgery
Definite Treatment
Open reduction with fixation
Syndesmotic fixation Immobilization with
posterior long leg cast for 8-12 wk
References Bharati S. Kalyani, MD; Craig S. Roberts, MD; Peter V.
Giannoudis, MD, FRCS; The Maisonneuve Injury: A Comprehensive Review, Orthopedics March 2010 - Volume 33 · Issue 3
www.orthobullets.com ; Ankle fractures by Ben Taylor www.radiologyassistant.nl www.youtube.com ; Dr. Nabil A. Ebraheim