Maisonneuve injury with no fibula fracture: A case report

Figure 1 Left ankle radiographs (from another hospital) of anteroposterior and lateral views showing medial malleolar fracture.

Figure 2 Postoperative radiograph showing the enlarged tibiofibular clear space and medial clear space.

Figure 3 Calf magnetic resonance imaging. A: Sagittal magnetic resonance imaging (MRI) showing high-signal intensity (orange arrow) indicating injury of the interosseous membrane (IOM); B: Coronal MRI showing IOM injury (orange arrow) compared with the contralateral uninjured calf; C: Axial MRI showing IOM rupture (orange arrow) compared with the contralateral uninjured calf, torn from the fibular interosseous crest.

Figure 4 Assessment of inferior tibiofibular syndesmosis in computed tomography scans. A: Bartoníček et al[6]’s evaluation method: The anterior aspect of the distal fibula and tibia was continuous, similar to the posterior aspect, “star” area of higher density of the subchondral cancellous bone; B: The distance between the Tillaux-Chaput tubercle and Gifford and Lutz[7]’s tibiofibular line did not exceed 2 mm at the level of 10 mm superior to the tibial plafond.

Figure 5 Computed tomography scans indicating complete injury of inferior tibiofibular syndesmosis. A: Rupture of the interosseous membrane (IOM) torn from fibular interosseous crest; B: Avulsion fracture of the anterior inferior tibiofibular ligament (AITFL) in the soft tissue window of computed tomography (CT) scan; C: Avulsion fracture of the posterior inferior tibiofibular ligament (PITFL) in the soft tissue window of CT scan; D: The intact IOM at the proximal part of the calf; E: Avulsion fracture of the AITFL was hardly caught in the bone window of the CT scan (the same B plane); F: Avulsion fracture of the PITFL was hardly caught in the bone window of the CT scan (the same C plane).

Figure 6 Ankle radiographs of anteroposterior and lateral views after secondary surgery. A: Anteroposterior; B: Lateral.