S82.86 Maisonneuve's fracture

Name of the Condition

• Maisonneuve's fracture

Summary

Maisonneuve's fracture is a specific type of ankle injury involving a proximal fibula fracture combined with a tear of the tibiofibular syndesmosis and often an associated medial malleolus or deltoid ligament injury. This injury typically results from rotational forces applied to the ankle, leading to instability in the ankle joint.

Causes

The fracture is usually caused by external rotation of the foot, which can occur during activities like twisting the ankle, falls, or sports-related injuries. The rotational force disrupts the syndesmotic ligaments and may cause additional damage to the medial structures of the ankle.

Risk Factors

• Participation in activities with high rotational stress on the ankle, such as soccer or basketball.
• Previous ankle injuries or ligamentous instability.
• Improper footwear or uneven terrain increasing fall risk.

Symptoms

• Pain and swelling localized to the proximal fibula and ankle.
• Difficulty bearing weight on the affected leg.
• Instability or a feeling of the ankle "giving way."
• Bruising or tenderness along the lower leg.

Diagnosis

Diagnosis involves a physical examination to assess ankle stability, tenderness, and swelling. Imaging, typically X-rays, is used to identify the proximal fibula fracture and associated injuries. Additional imaging, such as CT or MRI, may be required to evaluate syndesmotic or ligamentous damage.

Treatment Options

Treatment depends on fracture severity and instability. Stable fractures may be managed with immobilization (e.g., casting or bracing) and restricted weight-bearing. Unstable fractures often require surgical intervention to repair the syndesmosis and stabilize the ankle joint.

Prognosis and Follow-Up

Prognosis is generally good with appropriate treatment, though recovery may take several months. Follow-up care includes monitoring for healing, physical therapy to restore strength and mobility, and regular imaging to ensure proper alignment. Long-term outcomes depend on the extent of ligamentous or bony damage.

Complications

• Chronic ankle instability or recurrent sprains.
• Post-traumatic arthritis due to joint damage.
• Nonunion or malunion of the fibula fracture.
• Nerve or vascular injury in severe cases.

Lifestyle & Prevention

• Wear supportive footwear during high-risk activities.
• Use ankle braces or tape for added stability.
• Perform exercises to strengthen ankle muscles and improve balance.
• Avoid uneven surfaces or hazardous environments that increase fall risk.

When to Seek Professional Help

Seek immediate medical attention if you experience severe pain, inability to bear weight, visible deformity, or signs of nerve/vascular compromise (e.g., numbness, discoloration). Persistent swelling, instability, or difficulty walking after an injury also warrant evaluation.

Tips for Medical Coders

Document the presence of a proximal fibula fracture, syndesmotic injury, and any associated medial ankle damage to support the diagnosis. Ensure clinical notes specify the mechanism of injury (e.g., rotational force) and whether the fracture is stable or unstable, as these details may impact coding and treatment decisions.