Nonoperative treatment of Maisonneuve fractures

Purpose The aim of this study is to describe the basic pathoanatomical characteristics of a stable Maisonneuve fracture and mid-term results of its nonoperative treatment. Methods The study included 17 prospectively collected patients with a mean age of 59 years. The postinjury ankle CT had to meet the following criteria: nondisplaced or minimally displaced (up to 1 mm) fracture of medial malleolus, medial clear space less than 3 mm, nondisplaced or minimally displaced (up to 2 mm) fracture of posterior malleolus, anatomical position or minimal malposition of the distal fibula in the fibular notch (widening of the tibiofibular space up to 2 mm or external rotation of the distal fibula up to 10°). The average follow-up period was 34 months, the final follow-up included CT examination and functional evaluation based on AOFAS and FAOS scores. Results A medial malleolus fracture was recorded in 12% cases, a posterior malleolus fracture in 29% patients and a Tillaux-Chaput tubercle fracture in 18% cases. All fractures of the proximal fibula, medial and posterior malleolus healed within 3 months. The position of the distal fibula in the fibular notch did not change in 11 cases compared to the post-injury CT scan, improved slightly in 5 cases, and worsened slightly in 1 case. The average final AOFAS hindfoot score was 96.9 points and the average final FAOS score was 98.7%. Conclusion A stable form of the Maisonneuve fracture is characterized by no or minimal displacement on CT scans and can be successfully treated nonoperatively.