Syndesmosis lesions reach a consensus in the literature for surgical treatment in case of diastasis of the distal tibiofibular joint or associated fracture around the ankle ( 10- 12). Maisonneuve fractures are a part of syndesmotic lesions. Therefore, in theory, a Maisonneuve fracture is unstable, since both columns are affected ( 9). But if it is ruptured on 2 places, it becomes unstable. If the ring is ruptured on one place, which means that only one column is broken, the joint remains stable. Some authors consider the ankle as a ring where the bone and ligament structures contribute to its stability. The ankle joint can be considered as 2 columns: medial and lateral. Posterior tibiofibular ligament (PTFL) may be intact, resulting in partial diastasis of the mortise ( 8). Lesions most frequently associated with Maisonneuve fractures are the interosseous and anterior inferior tibiofibular ligaments (AITFL), the posterior malleolus, the deltoid ligament and the medial malleolus ( 7). Disruption of the interosseous membrane (IOM) usually progresses to the neck of the fibula with a concomitant spiral fracture. The force is then transmitted anteriorly, with the talus acting as a wedge, resulting in rupture of the anterior tibiofibular and interosseous ligaments. The sequence of the injury is described as follows: the talus performs an external rotation and creates a strain on the medial column of the mortise. The main injury mechanism proposed is an external rotation of a pronated and fixed foot ( 1). It is frequently a sport-related injury, occurring in a relatively young population ( 4- 6). Diagnosis is often overlooked and probably occurs more often than assumed among ankle fractures, Maisonneuve fractures accounting for 0.7% to 10% in some studies ( 2- 4). It was originally described by the French surgeon Jules Germain François Maisonneuve in 1840 ( 1). Maisonneuve fractures are characterised by a pattern of the following lesions: a medial malleolar fracture or deltoid ligament rupture, a disruption of the ankle syndesmosis ligaments and a fracture of the proximal fibula.
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