Diagnosis

44-C3 Suprasyndesmotic lesion, proximal fibular lesion (Maisonneuve)

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Type C3 fractures occur with the foot in pronation when an external rotation force applied. The first injury is a failure of the medial side either with a deltoid ligament rupture, or medial malleolar fracture. This frees the talus to move anteriorly as it rotates externally. The fibula is caused to rotate resulting in failure of the anterior syndesmotic ligament and then of the interosseous ligament. Finally the fibula fractures proximally, usually by rotation. This is a very unstable ankle joint lesion that always needs at least one, or better two, positioning screws.

44-C fractures correspond to pronation-eversion fractures in the Lauge-Hansen classification. 

Options
1. 44-C3.1 Without shortening, without Volkmann
2. 44-C3.2 With shortening, without Volkmann
3. 44-C3.3 With medial lesion, with Volkmann lesion

1. 44-C3.1 Without shortening, without Volkmann

44-C3.1

44-C3.1

Fibula
Proximal tibiofibular dislocation, or a fracture through the fibular neck or head. No fibular shortening.

Medial lesion
A rupture of the medial collateral ligament, or a transverse fracture of the medial malleolus.

Posterior tuberosity
No fracture.

Syndesmotic complex
The anterior and interosseous syndesmotic ligaments are always disrupted. The anterior ligament may fail as a ligamentous rupture, or an avulsion fracture, of the anterior syndesmotic ligament, either at its fibular (Le Fort / Wagstaff), or tibial (Tillaux-Chaput) insertion.

44-C3.1 AP and lateral view

44-C3.1 AP and lateral view

2. 44-C3.2 With shortening, without Volkmann

44-C3.2

44-C3.2

Fibula
Fracture through the fibular neck, or head, or proximal tibiofibular dislocation, resulting in shortening of the fibula.

Medial lesion
A rupture of the medial collateral ligament, or transverse fracture of the medial malleolus.

Posterior tuberosity
No fracture.

Syndesmotic complex
The anterior and interosseous syndesmotic ligaments are always disrupted. The anterior ligament may fail as a ligamentous rupture, or an avulsion fracture, of the anterior syndesmotic ligament, either at its fibular (Le Fort / Wagstaff), or tibial (Tillaux-Chaput) insertion.

44-C3.2 AP and lateral view

44-C3.2 AP and lateral view

3. 44-C3.3 With medial lesion, with Volkmann lesion

44-C3.3

44-C3.3

Fibula
A fracture through the fibular neck, or head, or proximal tibiofibular dislocation, resulting in shortening of the fibula.

Medial lesion
A rupture of the medial collateral ligament, or transverse fracture of the medial malleolus.

Posterior tuberosity
The fracture of the posterior tibial lip may be a small cortical avulsion. More often is a larger fragment, bearing a variable area of the posterior articular surface.

Syndesmotic complex
The anterior and interosseous syndesmotic ligaments are always disrupted. The anterior ligament may fail as a ligamentous rupture, or an avulsion fracture, of the anterior syndesmotic ligament, either at its fibular (Le Fort / Wagstaff), or tibial (Tillaux-Chaput) insertion. The posterior tibio-fibular ligament (posterior syndesmotic ligament) is usually intact and attached to the Volkmann fragment.

44-C3.3 AP and lateral view

44-C3.3 AP and lateral view

44-C3.3 AP view

44-C3.3 AP view