Management of an Individual With a Maisonneuve Fracture: A Case Report With 3-Year Follow-up

BACKGROUND: Maisonneuve fractures (MF) are caused by a traumatic ankle injury causing medial ligament rupture or medial malleolar fracture, distal tibia/fibula joint disruption and proximal fibula fracture resulting in ankle instability which can lead to post-traumatic ankle arthritis.

CASE PRESENTATION: A 58-year-old female fell snow skiing and was diagnosed with a right proximal fibula fracture in the emergency department. Due to concern of a Maisonneuve fracture (MF), her physical therapist (PT) referred the patient to a board certified, fellowship trained foot and ankle surgeon who confirmed the diagnosis of MF. The patient underwent TightRope^TM fixation with management by a PT for four months following surgery.

OUTCOME AND FOLLOW-UP: Post-surgery Lower Extremity Functional Scale (LEFS) scores were 79/80 at 60 weeks. At 2 and 3-years following surgery Y balance scores showed no significant differences Between affected and unaffected limbs. After 3 years, gait speed and step length were within normal limits with no deficits noted in limb comparison.

DISCUSSION: An accurate diagnosis for individuals sustaining a MF is important to optimize long-term outcomes. PTs can play a key role in the accurate and timely diagnosis of MF and their patients’ subsequent management to optimize recovery.