# Maisonneuve Fracture > Maisonneuve fracture for NEET-PG Orthopaedics, covering the proximal fibula break with syndesmotic and deltoid injury, and why the whole leg must be imaged. - Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/maisonneuve-fracture - Exam / course: NEET-PG · Subject: Orthopaedics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-14 - Last updated: 2026-10-14 - Reference basis: Apley's System of Orthopaedics and Fractures; Campbell's Operative Orthopaedics; Rockwood and Green's Fractures in Adults - How to cite: "Maisonneuve Fracture", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/maisonneuve-fracture ## Direct answer A Maisonneuve fracture is a fracture of the proximal fibula that accompanies disruption of the ankle syndesmosis and the medial side, produced by an external rotation injury of the ankle. The ankle may look only mildly injured on X-ray, so the whole leg must be imaged in any ankle injury with medial tenderness. Surgical stabilisation of the unstable ankle is usually required. ## What you must remember - **Injury sequence:** the medial side (deltoid ligament or medial malleolus) tears first, then the syndesmosis and interosseous membrane, and the proximal fibula breaks last. - **Mechanism:** an external rotation force on a pronated foot (Lauge-Hansen pronation-external rotation pattern), typical of a fall or a twisting sports injury. - **Clinical clue:** tenderness over the proximal fibula, the medial side or the syndesmosis, in an ankle that may look only mildly injured. - **Radiographic clue:** a widened medial clear space on the mortise view or a medial malleolar fracture signals instability. - **Imaging rule:** full-length films of the tibia and fibula, including the knee and ankle, are needed, because the proximal fibula is easily missed. - **Treatment:** the syndesmosis and the medial side are stabilised, and the proximal fibula usually needs no separate fixation once the ankle is stable. - **Nerve risk:** the common peroneal nerve lies close to the fibular neck, so its function should be documented. ## A stepwise approach to the twisted ankle A 45-year-old man twists his ankle on a kerb, with medial pain and an ankle film that looks only mildly abnormal. The steps below show how the injury is found when the presenting complaint is at the ankle but the damage is higher up the leg. 1. **Examine the proximal leg.** Palpate the fibular head and neck, because the proximal break is often painful and easily overlooked in an ankle injury. 2. **Image the whole leg.** Obtain AP and lateral films of the knee, leg and ankle, including the full length of the fibula. 3. **Read the ankle.** Check the medial clear space and the medial malleolus, because a widened space signals deltoid and syndesmotic disruption. 4. **Test the syndesmosis.** Perform the squeeze test and the external rotation test to confirm instability when the films are equivocal. 5. **Stabilise the ankle.** Fix the syndesmosis with screws or a suture-button device, and repair the medial side if the deltoid or malleolus is torn. 6. **Check the peroneal nerve.** Test foot dorsiflexion and eversion after injury, since the common peroneal nerve runs near the fibular neck. ## Where the exam tries to catch you Maisonneuve questions test whether the candidate looks above the ankle before labelling the injury a sprain. - **Trap:** accepting a mild-looking ankle X-ray despite medial tenderness. **Correct:** a Maisonneuve pattern must be excluded with full-length films before the injury is labelled a sprain. - **Trap:** ignoring the fibula because it was not the presenting complaint. **Correct:** the proximal fibula fracture is the clue, and it guides the decision to fix the syndesmosis. - **Trap:** assuming a proximal fibula fracture always needs plating. **Correct:** the proximal fibula usually heals without fixation once the ankle is stabilised. ## Frequently asked questions ### What is a Maisonneuve fracture? A Maisonneuve fracture is a proximal fibula fracture that accompanies disruption of the ankle syndesmosis and the medial side. It is caused by an external rotation injury of the ankle, and the ankle often looks only mildly injured on the initial films. ### Why must the whole leg be imaged in an ankle injury? The whole leg must be imaged because a Maisonneuve fracture of the proximal fibula is easily missed on ankle films alone. Full-length radiographs of the tibia and fibula reveal the proximal break that explains the syndesmotic injury. ### How is the syndesmosis tested clinically in a Maisonneuve injury? The syndesmosis is tested clinically with the squeeze test and the external rotation stress test, which reproduce pain or instability at the distal tibiofibular joint. Positive tests should be confirmed with radiographs, including a mortise view. ### Does a Maisonneuve fracture usually need surgery? A Maisonneuve fracture usually needs surgical stabilisation of the syndesmosis and the medial side, because the ankle is unstable. The proximal fibula generally heals once the ankle has been stabilised.