A 35-year-old man twists his ankle playing basketball. He has marked swelling over the medial malleolus and tenderness over the proximal calf. Radiographs show no medial malleolar fracture but reveal widening of the medial clear space and a spiral fracture of the proximal third of the fibula. The most appropriate management is:

• A Anatomic reduction of the ankle mortise with syndesmotic screw fixation ✓
• B ORIF of the proximal fibular fracture only
• C Closed reduction and below-knee cast immobilization
• D Early mobilization with an ankle brace and physiotherapy

Explanation

This is a Maisonneuve fracture: external rotation force disrupts the deep deltoid ligament, tears the interosseous membrane, and exits as a spiral proximal fibular fracture. The instability lies at the ankle mortise and syndesmosis, not the fibula itself, so treatment targets reduction of the mortise with syndesmotic stabilization. Casting alone cannot maintain reduction of the disrupted syndesmosis, and fixing the fibular fracture does nothing for the mortise.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.