Journal of Foot and Ankle Surgery - 2026-04-24 - Journal Article
"Maisonneuve Type" Fracture Patients Return to Activity Quicker than Patients with Other PER III/IV Fractures.
Vu NH, Linker J, Ganta A, Konda SR, Egol KA, Tejwani NC
Topics
Key Takeaway
Maisonneuve fracture patients achieved clinical healing and return to full activity faster than other PER III/IV fractures requiring fibular fixation, with no significant difference in complication rates.
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Summary
This study compared outcomes of operatively treated Maisonneuve fractures (syndesmotic disruption ± proximal fibula fracture) to other surgically managed PER III/IV ankle fractures requiring fibular fixation and syndesmotic stabilization. Maisonneuve patients demonstrated faster time to clinical healing and return to full activity on multivariable regression (p<0.05), and were more frequently male (p<0.05). Complication rates, fracture-related infection, hardware removal, nonunion, and radiographic parameters at 6 months showed no significant between-group differences.
Key Limitation
The total size of the comparison PER III/IV cohort is not reported, making it impossible to evaluate statistical power or generalizability of the between-group comparisons.
Original Abstract
PURPOSE
To compare clinical characteristics and outcomes of Maisonneuve fractures, as defined as syndesmotic disruption with or without proximal fibula fracture, to other pronation-external rotation (PER) stage III/IV fractures.
METHODS
A retrospective review of an IRB-approved database of ankle fractures from a single orthopedic department identified patients with surgically treated PER stage III/IV fractures, including those meeting radiographic criteria for Maisonneuve fracture. Data collected included patient demographics, injury mechanism, surgical details, and Lauge-Hansen classification. Maisonneuve fractures were compared to other PER III/IV fractures requiring fibular fixation with syndesmotic stabilization. Outcomes included total complications, fracture-related infection, hardware removal, and nonunion. Patients were seen for standard follow up for 12 months post-operatively with clinical healing defined as non-tenderness about the ankle. Statistical analyses included Chi square analysis, ANOVA, and multivariable regression analysis.
RESULTS
64 patients with operatively repaired Maisonneuve fractures were identified (mean follow-up of 10 months). These patients were more often male compared to other PER III/IV fractures (p < 0.05). Maisonneuve fractures were associated with a faster time to clinical healing and return to full activity, confirmed on multivariable regression analysis (p < 0.05). No significant differences in complications rates or radiographic parameters at six months or later were observed, as all values remained within accepted clinical ranges.
CONCLUSION
Maisonneuve fracture patients experience a more rapid clinical recovery based upon painless ankle motion as well as a return to full activity faster than patients with other types of PER III/IV injuries, with comparable complication rates and radiographic outcomes.