Arthroscopy and Percutaneous Internal Fixation in Maisonneuve Fractures. Imaging Evaluation
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Published:
Apr 16, 2024
Keywords:
Maisonneuve fracture, tibiofibular instability, syndesmotic injury, ankle arthroscopy, imaging evaluation
Main Article Content
Abstract
Introduction: Maisonneuve fracture (MF) is an injury characterized by the subcapital fracture of the fibula associated with a capsuloligamentous injury of the ankle. Treatment involves the restoration of normal bone and capsuloligamentous anatomy in order to reestablish physiological tibiotalar contact forces. This quality of reduction can be difficult to achieve, especially with percutaneous techniques.
Objective: To evaluate the quality of reduction in Maisonneuve fractures reduced in a closed manner (under direct arthroscopic visualization) and fixed percutaneously.
Materials and Methods: We analyzed comparative preoperative and postoperative radiographs and CT scans of the operated and healthy ankles.
Results: 13 fractures were evaluated. Radiographic parameters of postoperative procedures (medial clear space, distal tibiofibular overlap, tibiofibular clear space) did not register differences except for the anterior tibiofibular space, which had increased in 1 case. Postoperative tomographic measurements of tibiofibular clear space and anterior tibiofibular space showed 100% satisfactory reductions. Two patients presented altered distal tibiofibular overlap values with a difference greater than 2 mm compared to the healthy ankle.
Conclusion: We recommend arthroscopy for the management of MF as an intraoperative control tool for safer percutaneous fixation.
Objective: To evaluate the quality of reduction in Maisonneuve fractures reduced in a closed manner (under direct arthroscopic visualization) and fixed percutaneously.
Materials and Methods: We analyzed comparative preoperative and postoperative radiographs and CT scans of the operated and healthy ankles.
Results: 13 fractures were evaluated. Radiographic parameters of postoperative procedures (medial clear space, distal tibiofibular overlap, tibiofibular clear space) did not register differences except for the anterior tibiofibular space, which had increased in 1 case. Postoperative tomographic measurements of tibiofibular clear space and anterior tibiofibular space showed 100% satisfactory reductions. Two patients presented altered distal tibiofibular overlap values with a difference greater than 2 mm compared to the healthy ankle.
Conclusion: We recommend arthroscopy for the management of MF as an intraoperative control tool for safer percutaneous fixation.
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How to Cite
Herrera, H., Rofrano , M., Azulay, G., Andrés, S., Varaona, J. M., Pereira , F., & Tálamo, F. (2024). Arthroscopy and Percutaneous Internal Fixation in Maisonneuve Fractures. Imaging Evaluation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(2), 132-142. https://doi.org/10.15417/issn.1852-7434.2024.89.2.1713
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Clinical Research
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References
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2. Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg (1920) 1950;60(5):957-85. PMID: 15411319
3. Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma 2012;26(7):439-43. https://doi/org/10.1097/BOT.0b013e31822a526a
4. Beumer A, van Hemert WL, Niesing R, Entius CA, Ginai AZ, Mulder PGH, et al. Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res 2004;(423):227-34. https://doi.org/10.1097/01.blo.0000129152.81015.ad
5. Tunturi T, Kemppainen K, Pätiälä H, Suokas M, Tamminen O, Rokkanen P. Importance of anatomical reduction for subjective recovery after ankle fracture. Acta Orthop Scand 1983;54(4):641-7. https://doi.org/10.3109/17453678308992903
6. Yde J, Kristensen KD. Ankle fractures: supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment. Acta Orthop Scand 1980;51(6):981-90. https://doi.org/10.3109/17453678008990904
7. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int 2006;27(10):788-92. https://doi.org/10.1177/107110070602701005
8. Cornu O, Manon J, Tribak K, Putineanu D. Traumatic injuries of the distal tibiofibular syndesmosis. Orthop Traumatol Surg Res 2021;107(1S):102778. https://doi.org/10.1016/j.otsr.2020.102778
9. Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am 1956;38-A(4):761-81. PMID: 13331972
10. Burns WC 2nd, Prakash K, Adelaar R, Beaudoin A, Krause W. Tibiotalar joint dynamics: indications for the syndesmotic screw--a cadaver study. Foot Ankle 1993;14(3):153-8. https://doi.org/10.1177/107110079301400308
11. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 1976;58(3):356-7. PMID: 1262367
12. Dikos GD, Heisler J, Choplin RH, Weber TG. Normal tibiofibular relationships at the syndesmosis on axial CT imaging. J Orthop Trauma 2012;26(7):433-8. https://doi.org/10.1097/BOT.0b013e3182535f30
13. Nielson JH, Sallis JG, Potter HG, Helfet DL, Lorich DG. Correlation of interosseous membrane tears to the level of the fibular fracture. J Orthop Trauma 2004;18(2):68-74. https://doi.org/10.1097/00005131-200402000-00002
14. Manyi W, Guowei R, Shengsong Y, Chunyan J. A sample of Chinese literature MRI diagnosis of interosseous membrane injury in Maisonneuve fractures of the fibula. Injury 2000;31(Suppl 3):C107-10. https://doi.org/10.1016/s0020-1383(00)80038-8. 2014;38(1):83-8.
15. Bartoníček J, Rammelt S, Kašper Š, Malík J, Tuček M. Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination. Arch Orthop Trauma Surg 2019;139(4):497-506. https://doi.org/10.1007/s00402-018-3099-2
16. Merrill KD. The Maisonneuve fracture of the fibula. Clin Orthop Relat Res 1993;(287):218-23. PMID: 8448946
17. Duchesneau S, Fallat LM. The Maisonneuve fracture. J Foot Ankle Surg 1995;34(5):422-8.
https://doi.org/10.1016/S1067-2516(09)80016-1
18. Pankovich AM. Maisonneuve fracture of the fibula. J Bone Joint Surg Am 1976;58(3):337-42. PMID: 816799
19. Morris JR, Lee J, Thordarson D, Terk MR, Brustein M. Magnetic resonance imaging of acute Maisonneuve fractures. Foot Ankle Int 1996;17(5):259-63. https://doi.org/10.1177/107110079601700504
20. Sproule JA, Khalid M, O’Sullivan M, McCabe JP. Outcome after surgery for Maisonneuve fracture of the fibula. Injury 2004;35(8):791-8. https://doi.org/10.1016/S0020-1383(03)00155-4
21. Takao M, Ochi M, Oae K, Naito K, Uchio Y. Diagnosis of a tear of the tibiofibular syndesmosis. The role of arthroscopy of the ankle. J Bone Joint Surg Br 2003;85(3):324-9. https://doi.org/10.1302/0301-620x.85b3.13174
22. Summers HD, Sinclair MK, Stover MD. A reliable method for intraoperative evaluation of syndesmotic reduction. J Orthop Trauma 2013;27(4):196-200. https://doi.org/10.1097/BOT.0b013e3182694766
23. Cherney SM, Spraggs-Hughes AG, McAndrew CM, Ricci WM, Gardner MJ. Incisura morphology as a risk factor for syndesmotic malreduction. Foot Ankle Int 2016;37(7):748-54. https://doi.org/10.1177/1071100716637709
24. Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG. Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int 2009;30(5):419-26. https://doi.org/10.3113/FAI-2009-0419
25. Pelton K, Thordarson DB, Barnwell J. Open versus closed treatment of the fibula in Maissoneuve injuries. Foot Ankle Int 2010;31(7):604-8. https://doi.org/10.3113/FAI.2010.0604
2. Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg (1920) 1950;60(5):957-85. PMID: 15411319
3. Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. J Orthop Trauma 2012;26(7):439-43. https://doi/org/10.1097/BOT.0b013e31822a526a
4. Beumer A, van Hemert WL, Niesing R, Entius CA, Ginai AZ, Mulder PGH, et al. Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res 2004;(423):227-34. https://doi.org/10.1097/01.blo.0000129152.81015.ad
5. Tunturi T, Kemppainen K, Pätiälä H, Suokas M, Tamminen O, Rokkanen P. Importance of anatomical reduction for subjective recovery after ankle fracture. Acta Orthop Scand 1983;54(4):641-7. https://doi.org/10.3109/17453678308992903
6. Yde J, Kristensen KD. Ankle fractures: supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment. Acta Orthop Scand 1980;51(6):981-90. https://doi.org/10.3109/17453678008990904
7. Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int 2006;27(10):788-92. https://doi.org/10.1177/107110070602701005
8. Cornu O, Manon J, Tribak K, Putineanu D. Traumatic injuries of the distal tibiofibular syndesmosis. Orthop Traumatol Surg Res 2021;107(1S):102778. https://doi.org/10.1016/j.otsr.2020.102778
9. Close JR. Some applications of the functional anatomy of the ankle joint. J Bone Joint Surg Am 1956;38-A(4):761-81. PMID: 13331972
10. Burns WC 2nd, Prakash K, Adelaar R, Beaudoin A, Krause W. Tibiotalar joint dynamics: indications for the syndesmotic screw--a cadaver study. Foot Ankle 1993;14(3):153-8. https://doi.org/10.1177/107110079301400308
11. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 1976;58(3):356-7. PMID: 1262367
12. Dikos GD, Heisler J, Choplin RH, Weber TG. Normal tibiofibular relationships at the syndesmosis on axial CT imaging. J Orthop Trauma 2012;26(7):433-8. https://doi.org/10.1097/BOT.0b013e3182535f30
13. Nielson JH, Sallis JG, Potter HG, Helfet DL, Lorich DG. Correlation of interosseous membrane tears to the level of the fibular fracture. J Orthop Trauma 2004;18(2):68-74. https://doi.org/10.1097/00005131-200402000-00002
14. Manyi W, Guowei R, Shengsong Y, Chunyan J. A sample of Chinese literature MRI diagnosis of interosseous membrane injury in Maisonneuve fractures of the fibula. Injury 2000;31(Suppl 3):C107-10. https://doi.org/10.1016/s0020-1383(00)80038-8. 2014;38(1):83-8.
15. Bartoníček J, Rammelt S, Kašper Š, Malík J, Tuček M. Pathoanatomy of Maisonneuve fracture based on radiologic and CT examination. Arch Orthop Trauma Surg 2019;139(4):497-506. https://doi.org/10.1007/s00402-018-3099-2
16. Merrill KD. The Maisonneuve fracture of the fibula. Clin Orthop Relat Res 1993;(287):218-23. PMID: 8448946
17. Duchesneau S, Fallat LM. The Maisonneuve fracture. J Foot Ankle Surg 1995;34(5):422-8.
https://doi.org/10.1016/S1067-2516(09)80016-1
18. Pankovich AM. Maisonneuve fracture of the fibula. J Bone Joint Surg Am 1976;58(3):337-42. PMID: 816799
19. Morris JR, Lee J, Thordarson D, Terk MR, Brustein M. Magnetic resonance imaging of acute Maisonneuve fractures. Foot Ankle Int 1996;17(5):259-63. https://doi.org/10.1177/107110079601700504
20. Sproule JA, Khalid M, O’Sullivan M, McCabe JP. Outcome after surgery for Maisonneuve fracture of the fibula. Injury 2004;35(8):791-8. https://doi.org/10.1016/S0020-1383(03)00155-4
21. Takao M, Ochi M, Oae K, Naito K, Uchio Y. Diagnosis of a tear of the tibiofibular syndesmosis. The role of arthroscopy of the ankle. J Bone Joint Surg Br 2003;85(3):324-9. https://doi.org/10.1302/0301-620x.85b3.13174
22. Summers HD, Sinclair MK, Stover MD. A reliable method for intraoperative evaluation of syndesmotic reduction. J Orthop Trauma 2013;27(4):196-200. https://doi.org/10.1097/BOT.0b013e3182694766
23. Cherney SM, Spraggs-Hughes AG, McAndrew CM, Ricci WM, Gardner MJ. Incisura morphology as a risk factor for syndesmotic malreduction. Foot Ankle Int 2016;37(7):748-54. https://doi.org/10.1177/1071100716637709
24. Miller AN, Carroll EA, Parker RJ, Boraiah S, Helfet DL, Lorich DG. Direct visualization for syndesmotic stabilization of ankle fractures. Foot Ankle Int 2009;30(5):419-26. https://doi.org/10.3113/FAI-2009-0419
25. Pelton K, Thordarson DB, Barnwell J. Open versus closed treatment of the fibula in Maissoneuve injuries. Foot Ankle Int 2010;31(7):604-8. https://doi.org/10.3113/FAI.2010.0604