Optimal management of ankle syndesmosis injuries.

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Abstract

8. Eur J Trauma Emerg Surg. 2026 Jun 8;52(1):180. doi: 10.1007/s00068-026-03229-x. Nonoperative treatment of Maisonneuve fractures. Frühauf J(1), Bartoníček J(1), Fojtík P(1), Horňáková A(2), Tuček M(3). Author information: (1)Department of Orthopaedics, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, Prague 6, 169 02, Czech Republic. (2)Institute of Hygiene and Epidemiology of the 1st Faculty of Medicine and General, University Hospital in Prague, Studničkova 7, Prague 6, 128 00, Czech Republic. (3)Department of Orthopaedics, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, Prague 6, 169 02, Czech Republic. tucekmic@gmail.com. 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. © 2026. The Author(s). DOI: 10.1007/s00068-026-03229-x PMCID: PMC13246575