A 28-year-old man twists his ankle during a fall. Radiographs show a transverse fracture of the medial malleolus and widening of the ankle mortise, but the fibula appears normal on ankle views. The entire leg is imaged and a spiral fracture of the proximal third of the fibula is found. What is the diagnosis?
- A Maisonneuve fracture ✓
- B Pilon fracture
- C Dupuytren fracture
- D Bosworth fracture
Correct answer: A. Maisonneuve fracture
Explanation
A proximal fibular spiral fracture combined with an ankle injury indicates a Maisonneuve fracture, caused by external rotation force that ruptures the syndesmosis and interosseous membrane up to the proximal fibula. Pilon is an intra-articular distal tibial plafond fracture. Dupuytren disrupts the syndesmosis but the fibular fracture is at or below the level of the joint. Bosworth involves posterior fibular entrapment behind the tibia.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
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