Maisonneuve fracture with an associated distal fibular fracture. A case report.

A 46-year-old woman had a severe torsional injury to her left leg. Admission radiographs showed a proximal Maisonneuve-type fibular fracture with an associated distal fibular fracture at the level of the distal tibiofibular syndesmosis. A complete syndesmotic disruption, proximal and distal to the distal fibular fracture, was verified at surgical exploration as was a complete deltoid ligament tear. Management consisted of internal fixation of the distal fibular fracture and placement of a syndesmotic screw. At 1-year followup, the patient reported normal ankle function. This case represents an unusual, and perhaps previously undescribed, variant of the so-called Maisonneuve fracture. The need for careful evaluation of the entire leg in torsional injuries of the ankle is underscored by the injury presented.