A 35-year-old man presents after a twisting ankle injury with swelling and bruising around the right ankle. He walks with difficulty. Radiographs show a transverse fracture of the medial malleolus with widening of the tibiofibular clear space, and he has marked tenderness over the proximal third of the calf. The most likely diagnosis is:

• A Gastrocnemius tear (tennis leg)
• B Isolated bimalleolar ankle fracture
• C Tibialis posterior tendon rupture
• D Maisonneuve fracture ✓

Explanation

D Maisonneuve fracture is a proximal fibular fracture produced by a pronation external rotation force that disrupts the distal tibiofibular syndesmosis and interosseous membrane. The ankle may look trivially injured while the real instability lies proximally, so the proximal fibula must be palpated in every significant ankle injury. Management centres on restoring and fixing the syndesmosis, not the fibula itself.

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.