Maisonneuve fractures involve the disruption of the syndesmosis and necessitate surgical intervention. The aim of surgery is to restore fibula length and stabilize the syndesmosis. Classic manual reduction may not achieve fibular lengthening and is strenuous to maintain during syndesmosis fixation. Hence, we report our method of reduction with a distraction technique that provides mechanical advantages. We present a case series of 3 patients with Maisonneuve fractures in which indirect fibular reduction was achieved using a novel distraction technique with instruments. Cases 1 and 2 suffered an isolated high fibular fracture, whereas Case 3 had concomitant ankle fractures. Syndesmosis disruption was confirmed intraoperatively with the Cotton and external rotation tests. All 3 cases underwent dual-suture button fixation of the syndesmosis. To achieve the reduction, a 3-hole plate was applied on the distal fibula fragment with a cortical screw applied over the most proximal hole. Subsequently, a 5 mm Steinmann pin was drilled into the lateral tibia. The entry point of the tibial pin is immediately anterior to the fibula and 2 cm proximal to the applied fibular plate. An edged lamina spreader was used to apply distraction between the plate and the Steinmann pin. Temporary reduction is held with a quadcortical K-wire, followed by suture button fixation through the middle and inferior holes of the fibular plate. Postoperative imaging showed a normal talocrural angle and the fibula dime sign. This technique provides mechanical advantages in strength and stability, maintaining the reduction while freeing the surgeon’s hands to perform syndesmosis fixation. Level of Evidence: Level lV.
Sim et al. (Thu,) studied this question.