M Wang1, C Jiang, S Yang, G Rong. 1. Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing 100035.
Abstract
OBJECTIVE: To study the traumatic mechanism and clinical treatment of Maisonneuve fracture. METHOD: 19 of 25 patients (6 - 60 months, average 16.8 months) were followed up. 11 patients were operated on and 8 were treated conservatively. Of the 25 patients, 8 had MRI. Osteotomy and serial section of the interosseous membrane (IOM) on fresh cadaveric specimens were doc carried out to observe the diastasis on stress mortise view. RESULT: Functional rehabilitation of the ankle joint: in 11 operative cases, 8 showed good results and 3 fair. In 8 conservative cases, 3 showed good results, 2 fair and 2 poor. MRI: IOM was ruptured in a range 3 - 8 cm proximal to the tibial plafond in the 8 cases. No IOM rupture was found at the high fibular fracture level. Fresh cadaveric experiment: fixation of the medial side alone can not control the syndesmotic diastasis on the artificial Maisonneuve fracture model made on cadaveric specimen. CONCLUSION: The injury level of the IOM during Maisonneuve fracture may not be consistent with the high fibular fracture. The limited external rotation of the fibula during injury by the superior tibio-fibular syndesmosis comprise to the high level fibular fracture. ORIF with syndesmotic fixation is recommended for the treatment.
OBJECTIVE: To study the traumatic mechanism and clinical treatment of Maisonneuve fracture. METHOD: 19 of 25 patients (6 - 60 months, average 16.8 months) were followed up. 11 patients were operated on and 8 were treated conservatively. Of the 25 patients, 8 had MRI. Osteotomy and serial section of the interosseous membrane (IOM) on fresh cadaveric specimens were doc carried out to observe the diastasis on stress mortise view. RESULT: Functional rehabilitation of the ankle joint: in 11 operative cases, 8 showed good results and 3 fair. In 8 conservative cases, 3 showed good results, 2 fair and 2 poor. MRI: IOM was ruptured in a range 3 - 8 cm proximal to the tibial plafond in the 8 cases. No IOM rupture was found at the high fibular fracture level. Fresh cadaveric experiment: fixation of the medial side alone can not control the syndesmotic diastasis on the artificial Maisonneuve fracture model made on cadaveric specimen. CONCLUSION: The injury level of the IOM during Maisonneuve fracture may not be consistent with the high fibular fracture. The limited external rotation of the fibula during injury by the superior tibio-fibular syndesmosis comprise to the high level fibular fracture. ORIF with syndesmotic fixation is recommended for the treatment.