Atypical pattern of Maisonneuve’s fracture–dislocation

The following is a description of a slightly frequent pattern of fracture–dislocation of ankle, which is not catalogued as the habitual classifications, providing clinical and radiological images of the injury and the applied treatment. A 30-year-old patient suffers entorsis of the left ankle by a forced mechanism of external rotation and supination. The initial radiological study shows tibio-astragaline dislocation, with the tibia intact, rupture of the tibiofibular syndesmosis and fracture of the medial 1/3 of the fibular diaphysis. It is operated by performing a percutaneous fixation of the syndesmosis with two tricortical screws. The deltoid ligament shows the complete breakage, as well as the presence of a detached small bone fragment of the posterior malleolus. The deltoid ligament is sutured, and the small osseous fragment of the posterior malleolus is removed. Recovery is uneventful and in 6 months after the injury, the patient returns to normal mobility without pain. In conclusion, the pattern of the fracture–dislocation of the ankle described is very rare, having found only one similar case in the literature, with the difference that we obtained the closed reduction of the dislocation and posterior stabilization with percutaneous fixation by two tricortical screws.