The proximal fibula should be examined in all patients with ankle injury: a case series of missed maisonneuve fractures.
BACKGROUND
The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula. It occurs from violent twisting of the ankle that characteristically causes ligament damage and severe instability. Most patients complain of significant ankle pain but very little pain over the fracture. The clinical and radiographic examination is usually directed to the ankle region; and the proximal fibula is often ignored.


OBJECTIVE
The authors intend to show the ease of missing the proximal fibular fracture when the clinical examination is directed to the ankle region. They discuss the importance of palpating the proximal fibula and ordering appropriate radiographs.


METHODS
The authors report on 5 patients who presented to the Emergency Department, where the Maisonneuve fracture was missed despite having ankle radiographs taken. All patients required open reduction and internal fixation.


CONCLUSIONS
The Maisonneuve fracture injury pattern causes untoward consequences if not promptly recognized and treated. To avoid misdiagnosis, the proximal fibula should be examined in all patients with ankle injury.
Rothman Institute, Foot and Ankle Service, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Nicholas R
NR
Taweel
Steven M
SM
Raikin
Homyar N
HN
Karanjia
Jamal
J
Ahmad
D000328:Adult; D016512:Ankle Injuries / Q000150:complications*; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013180:Sprains and Strains / Q000150:complications