Which fracture is the fracture of the proximal third of the fibula with rupture of the distal tibiofibular syndesmosis?

• A. Tillaux
• B. Lisfranc
• C. Maisonneuve
• D. Jones

Answer: (C)

Recognition of a Maisonneuve fracture: a proximal third fibula fracture with rupture of the distal tibiofibular syndesmosis, typically from an eversion-external rotation mechanism. The same force that twists the ankle outward can tear the syndesmosis and shear the proximal fibula through the interosseous membrane, so you get an injury high up the leg even though the pain may seem centered at the ankle. Clinically, there may be ankle pain and swelling with tenderness along the distal tibiofibular joint, and imaging should include views of the entire leg to assess the proximal fibula and the ankle mortise for syndesmotic injury. Treatment requires immobilization and urgent orthopedic input to address the syndesmotic disruption and prevent chronic instability. The other patterns involve different anatomical sites: Tillaux is a distal tibial physeal fracture in adolescents; Lisfranc is a midfoot injury at the tarsometatarsal joints; Jones is a fracture of the proximal diaphysis of the fifth metatarsal, not involving the fibula or ankle syndesmosis.