Taweel Nicholas R, Raikin Steven M, Karanjia Homyar N, Ahmad Jamal
Rothman Institute, Foot and Ankle Service, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
J Emerg Med. 2013 Feb;44(2):e251-5. doi: 10.1016/j.jemermed.2012.09.016. Epub 2012 Oct 15.
The Maisonneuve fracture is a spiral fracture of the proximal third of the fibula. It occurs from violent twisting of the ankle that characteristically causes ligament damage and severe instability. Most patients complain of significant ankle pain but very little pain over the fracture. The clinical and radiographic examination is usually directed to the ankle region; and the proximal fibula is often ignored.
The authors intend to show the ease of missing the proximal fibular fracture when the clinical examination is directed to the ankle region. They discuss the importance of palpating the proximal fibula and ordering appropriate radiographs.
The authors report on 5 patients who presented to the Emergency Department, where the Maisonneuve fracture was missed despite having ankle radiographs taken. All patients required open reduction and internal fixation.
The Maisonneuve fracture injury pattern causes untoward consequences if not promptly recognized and treated. To avoid misdiagnosis, the proximal fibula should be examined in all patients with ankle injury.
Maisonneuve骨折是腓骨近端三分之一处的螺旋骨折。它由踝关节剧烈扭转引起，其特征是导致韧带损伤和严重不稳定。大多数患者主诉踝关节剧痛，但骨折部位疼痛很轻。临床和影像学检查通常针对踝关节区域；腓骨近端常常被忽视。
作者旨在表明当临床检查针对踝关节区域时，很容易漏诊腓骨近端骨折。他们讨论了触诊腓骨近端和开具合适的X线片的重要性。
作者报告了5例到急诊科就诊的患者，尽管拍摄了踝关节X线片，但仍漏诊了Maisonneuve骨折。所有患者均需要切开复位内固定。
如果Maisonneuve骨折损伤模式未得到及时识别和治疗，会导致不良后果。为避免误诊，所有踝关节损伤患者均应检查腓骨近端。
