title: Evidence-based treatment of maisonneuve fractures.
abstract: The objective of the current study was to review the published clinical evidence available for the treatment of Maisonneuve fractures. Medline via PubMed, Orthopaedic Trauma Association (OTA) annual meetings' abstracts archives Web site, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Clinical Trial register were searched for the period extending from January 1970 to May 2009 in order to identify studies relating to the treatment of Maisonneuve ankle fractures. Six level 4 (case series, N ≥ 5) studies, describing a total of 83 patients with a Maisonneuve fracture, were included in the review. Although the authors did not compare the different treatment strategies described in the reports, the overall outcomes were generally good, and included 74 (89%) patients in which the outcome was considered good or excellent, and 9 (11%) patients in which the outcome was considered fair or poor. Based on this review, some grade B and C recommendations for the treatment of Maisonneuve fractures were formulated, including: 1) the medial malleolus should be fixated, 2) the torn deltoid ligament need not be directly repaired, 3) syndesmotic instability can be treated with one or two 3- or 4-cortical screws and these can be placed percutaneously, and 4) the proximal fibular fracture does not require direct internal fixation. Recommendations for future research were also formulated and described in this report.
authors.affiliation: Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Sjoerd A
authors.initials: SA
authors.lastname: Stufkens
authors.forename: Michel P J
authors.initials: MP
authors.lastname: van den Bekerom
authors.forename: Job N
authors.initials: JN
authors.lastname: Doornberg
authors.forename: C Niek
authors.initials: CN
authors.lastname: van Dijk
authors.forename: Peter
authors.initials: P
authors.lastname: Kloen
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods* / Q000534:rehabilitation; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D007593:Joint Instability / Q000517:prevention & control; D008297:Male; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult