Bartoníček J, Fojtík P, Bunganičová E, Tuček M
Rozhl Chir. 2023 Spring;102(2):48-59. doi: 10.33699/PIS.2023.102.2.48-59.
Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior and interosseous tibiofibular ligaments. Other injuries are variable. Recent CT studies have demonstrated that MF is a far more complex injury than initially supposed. Therefore it is necessary to change substantially the current concepts related to this issue. MF is combined in about 80% of cases with a fracture of the posterior malleolus and also with malposition of the distal fibula in the fibular notch. An exact assessment of these injuries requires post-injury CT examination which should be used as a standard in MFs. The main goal of treatment is anatomical reduction of the distal fibula into the fibular notch. In case of avulsion of a larger fragment of the posterior malleolus, it is necessary to perform as the first step its reduction and fixation from the posterolateral approach and thus restore integrity of the notch. Closed reduction of the distal fibula is associated with malposition in up to 50% of cases and therefore open reduction from a short anterolateral approach is preferred. Accuracy of reduction should be always checked by postoperative CT scan.
马松纽夫骨折（MF）被定义为一种踝关节骨折脱位，总是伴有腓骨近端四分之一骨折以及胫腓前韧带和骨间韧带断裂。其他损伤情况各异。近期的CT研究表明，MF是一种比最初认为的要复杂得多的损伤。因此，有必要大幅改变当前与此问题相关的概念。约80%的MF病例合并有后踝骨折以及腓骨远端在腓骨切迹中的位置异常。对这些损伤的准确评估需要伤后CT检查，这应作为MF的标准检查方法。治疗的主要目标是将腓骨远端解剖复位至腓骨切迹。如果后踝有较大骨块撕脱，第一步必须从后外侧入路对其进行复位和固定，从而恢复切迹的完整性。腓骨远端闭合复位在高达50%的病例中会伴有位置异常，因此首选从短的前外侧入路进行切开复位。复位的准确性应始终通过术后CT扫描进行检查。
