I was placed in a split cast to stabilize it for the first two weeks. Nothing was really done about the higher up fracture because it was in line and there isn't a lot you can do except rest it and let it heal.įrom the beginning, the pain wasn't really all that bad, mostly numb then a kind of aching. Also I had torn some ligaments which were repaired. On the lateral aspecit of my ankle another incision was made and a plate and 4 screws were placed to bring the two bones back together. I had an incision on the medial aspect of my ankle where two screws were inserted into the medial malleolus. The injury happened on Sunday and I had surgery by an orthopedic surgeon who specializes in ankle fracures the next Thursday. This is apparently the classic presentation of a maisonneuve fracture and requires surgery. Xrays also showed significant widening of the syndesmosis which is the area where the two lower legs bones come together. I had also snapped the fibula (the outside bone of the lower leg) almost 2/3 of the way up towards the knee. Xrays showed I had broken off the tip of the medial malleolus which is the end point of the tibia the bone that is towards the inside of the foot. He examined it and thought it should be xrayed. I figured I had a sprain and called out to my husband (a physican). I went to get up on it and quickly decided that wasn't a good idea. After recovering a moment at the bottom ( fell on the last three steps) I noticed my ankle was uncomfortable and sort of numb.
I broke it coming down my stairs (in socks) and pitched forward with my hands out to prevent braining myself on our slate floor. I am 52 years old and and now I am now 4 weeks post fracture and 3 weeks and 4 days post open reduction and internal fixation surgery to repair my ankle. Clearly, people heal and recover at different rates which expands the definition of normal. McGraw-Hill Education.Since fracturing my ankle in a fall, I've found it helpful to read other people's accounts of recovery as it gives me a sense of what to expect and how I am doing overall. Tintinalli’s emergency medicine A comprehensive study guide. Should reduce and place in a short leg splint, non-weight bearing, immediate orthopedic consult to be seen while in ED.Īdmit patients with open fractures or neurovascular compromise
If untreated the instability can lead to chronic pain and long-term disability. Maisonneuve fractures are associated with ankle instability, require surgery. Weakness of ankle dorsiflexion/subtalar joint (foot) eversion and/or numbness along the lateral lower leg/dorsum of the foot should raise clinical suspicion The common peroneal nerve courses over fibular head. Ankle and/or distal lower leg pain is considered a positive test, suggests syndesmotic injury. Perform Squeeze Test : compression of the tibia/fibula just above the ankle joint. In addition to imaging of the ankle, tib-fib x-rays should also be obtained to evaluate the entire length of tibia/fibula.Īnkle radiographs can appear “normal” (may only have an occult deep deltoid ligament injury with minimal medial clear space wideningĪ s tress view of the ankle should be obtained to help identify deep deltoid ligament with associated ankle joint instability.Įxamine all patients with ankle injuries for tenderness along the entire length of the fibula Tenderness over the proximal fibula in a patient with an “ankle sprain” or with displaced ankle fractures, including distal fibular fracturesĪbnormal when tibiofibular space >5mm, medial clear space >4mm Widening of the distal tibiofibular joint without a distal fibular fracture Medial malleolar fracture or deltoid ligament tear without a distal fibular fracture Tibiofibular syndesmosis: fibrous interosseous membrane connecting the tibia/fibula. The fibula fracture usually occurs in proximal third but can be as distal as 6 cm above the ankle joint. Involves a ligamentous injury (distal tibiofibular syndesmosis +/- deep deltoid ligament) and/or fracture of the medial/posterior malleolus.
Proximal fibula fracture + unstable ankle joint injury Maisonneuve fracture results from an external rotation force applied to the footįorce at the medial ankle -> force is directed laterally, tearing the interosseous membrane that tethers the distal tibia to the fibula -> force directed upwards fracturing fibula