Evidence-based treatment of maisonneuve fractures

The objective of the current study was to review the published clinical evidence available for the treatment of Maisonneuve fractures. Medline via PubMed, Orthopaedic Trauma Association (OTA) annual meetings' abstracts archives Web site, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Clinical Trial register were searched for the period extending from January 1970 to May 2009 in order to identify studies relating to the treatment of Maisonneuve ankle fractures. Six level 4 (case series, N ≥ 5) studies, describing a total of 83 patients with a Maisonneuve fracture, were included in the review. Although the authors did not compare the different treatment strategies described in the reports, the overall outcomes were generally good, and included 74 (89%) patients in which the outcome was considered good or excellent, and 9 (11%) patients in which the outcome was considered fair or poor. Based on this review, some grade B and C recommendations for the treatment of Maisonneuve fractures were formulated, including: 1) the medial malleolus should be fixated, 2) the torn deltoid ligament need not be directly repaired, 3) syndesmotic instability can be treated with one or two 3- or 4-cortical screws and these can be placed percutaneously, and 4) the proximal fibular fracture does not require direct internal fixation. Recommendations for future research were also formulated and described in this report.