| Background: In 1840, Maisonneuve, a France surgeon found an ankle fracture that consisted fracture of medial malleolus, inner structural damage of ligamentum deltoideum and tibiofibular syndesmosis, along with high fibular fracture. We named it Maisonneuve Fracture of Fibular(MFF). MFF has III or IV degrees of damage, on the basis of Lauge-Hansen classification that is pronation- external rotation injury. Misseddiagnosis of MFF occurs frequently, due to its low incidence, the complex mechanism of injury, relatively hidden symptoms of damage of ligament deltoideum, tibiofibular syndesmosis and high fibular fracture, which affect the treatment, then cause poor prognosis, recent or long-term complications worsen the quality of patient life. In recent years, The incidence of MFF is increasing along with the ankle fracture is becoming increasingly common in clinical practice, cause of aging population, and frequently traffic injuries along with the rapid development of transport. Then, practitioners and researchers expend more and more attention on MMF.。Objectives:(1) Analyze the feature and mechanism of MFF.(2) Explore the reason of missed diagnosis of MFF.(3) Discuss the methods and effects of conservative and surgical treatment.Methods: Select 14 cases of MFF, admitted to The First Affiliated Hospital of Dalian Medical University during Jan, 2003 to Jan 2015. Among them, Male, 9; female, 5, Age,19 to 63, average 40.1. All patients had a clear history of trau-ma, among them traffic injury 4 cases, fall 3cases, sports related injuries 3 cases. All of them are closed fracture, 12 of them along with after ankle fracture, the syndesmosis separation is 3 cases, 2 of them with Triangular ligament tear. Foll ow-up adopt ways including telephone follow-up, onsite examination and back fo r review. Assess postoperative recovery in accordance with the AOFAS Ankle Hi-ndfoot Scale. Statistical protocols are used to analyze the relevant data.Results:(1) There are 3 patients with missed diagnosis in 14, the rate is 21%. One case after ankle fracture misdiagnosis, the other two was missing the diagnosis of syndesmotic injury.(2) According to the scale of AOFAS, among 11 post-operated patients, the cases get a score of 89. And the excellent and good rate is reaching 81.8%.(3) There are 8 cases belonging to the III° of Lauge-Hansen pronation-lateral rotation type, 3 cases of the IV°. The follow-up find that there are 7 III° patients receiving an excellent outcome, 1 with a fine outcome. Meanwhile, in the remaining 3 patients with IV° injury, 2 of them get an excellent outcome, 1 with a fine outcome. There is no statistical difference of post-operation follow-up.(4) 2 of the operating group missed diagnosis of a syndesmotic The 2 cases present a sign of unstable ankle joint, and in a long-term fellow-up, the surgical joint pain shows, as well as a limited mobility in this part. However, there are no such condition in the other cases. All the cases in operating group are treated with one or two 3 cortical screws.(5) 8 of the III° patients fix the medial malleolus or the deltoid ligament with cannulated screws, 3 IV° case are all deal with a repaired hough. And there are no severe complications in all the cases.Conclusions:(1) The Maisonneuve fracture of fibular is a easily missed-diagnosed disease in clinic, a complete physical examination and a X-ray image including proximal fibula is the fundamental trick to avoid the missed diagnosis,(2) Operating treatment is preferred in this kind of injury due to the unstable ankle joint. The main purpose is repairing the internal structures, fixing the syndesmotic, and dealing with the hough fracture.(3) Both the III° and IV° patients can get an excellent or a good outcome, and there are obvious statistical difference,the III° fracture has a better recover expect than the IV°. |
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