Maisonneuve Fracture – The Ankle Injury That Hides in the Knee

Maisonneuve Fracture – The Ankle Injury That Hides in the Knee You twisted your ankle, your lower leg hurts, but the ankle X rays come back normal. Your doctor clears you to go home. Weeks later, you're still in pain and swelling hasn't improved. Could there be a fracture you've missed? Welcome to the Maisonneuve fracture—a deceptive injury where damage to your ankle actually involves a break much higher up in your leg. If you've had ankle trauma and lingering symptoms in Central Florida, understanding Maisonneuve fracture could explain your ongoing pain. What Is a Maisonneuve Fracture? A Maisonneuve fracture is a specific type of ankle injury involving two separate fractures in your leg: 1. A break in the fibula (smaller bone in the lower leg) near the knee 2. Disruption to the syndesmosis —the fibrous connection between the tibia and fibula at the ankle The injury pattern resembles a simple ankle sprain or minor fracture on initial examination, but the fibular break near the knee is often missed because the injury occurred at the ankle, and doctors may not image the area of pain. This fracture pattern is named after French surgeon Jacques Maisonneuve, who first described it in the 1800s. Despite its age, it remains frequently underdiagnosed in emergency departments and urgent care facilities across Florida and nationwide. How Maisonneuve Fractures Happen These injuries typically result from external rotation of the foot while your leg is fixed—imagine your foot turning outward while your knee stays pointed forward. Common causes include: Sports injuries —football, soccer, basketball, or any activity involving rapid directional changes Falls —particularly stepping off a curb or uneven surface and twisting your ankle Motor vehicle accidents —lower leg trauma with rotational forces High impact activities —running on uneven terrain The rotation forces fracture the fibula high up near the knee while simultaneously disrupting the ankle's syndesmotic ligaments. Because the pain is often perceived at the ankle, the injury site near the knee is overlooked. Symptoms: Why They're Confusing Maisonneuve fractures present with deceptive symptom patterns: Ankle pain and swelling —mimicking a standard ankle sprain Knee pain and swelling —which doctors might attribute to a separate injury Difficulty bearing weight —your entire leg feels unstable Persistent symptoms —pain and swelling don't improve with typical ankle sprain treatment Feeling of instability —your ankle feels loose or unreliable, even after supposed "recovery" Radiating discomfort —pain along the inside of the leg between ankle and knee Many patients spend weeks treating what they think is an ankle sprain, growing increasingly frustrated when healing plateaus and standard interventions fail. Diagnosis: Why These Injuries Are Missed The challenge with Maisonneuve fractures is that imaging the ankle alone misses the fibular fracture near the knee . At CFFAI's Downtown Orlando, Altamonte Springs, Longwood, Lake Mary, and Sanford locations, Dr. Robert Hoover uses comprehensive diagnostic protocols: Complete Physical Examination We examine your entire lower leg—not just the ankle—looking for tenderness, swelling, and instability along the fibula from knee to ankle. Proper Imaging Ankle X rays —may show syndesmotic widening even without obvious fibular fracture at the ankle Full leg X rays or knee X rays —essential to visualize the fibular fracture near the knee CT imaging —provides detailed views of complex fracture patterns MRI —shows soft tissue damage and syndesmotic injury Critical point: If your initial ankle X rays were normal but your pain persists, insist on imaging of the entire lower leg, particularly around the knee. Treatment: Why Standard Ankle Care Fails Standard ankle sprain treatment—rest, ice, compression, elevation (RICE), and then progressive physical therapy—fails for Maisonneuve fractures because the fibular fracture requires immobilization and protected weight bearing. Conservative Management For non displaced fractures without significant syndesmotic injury: Immobilization —boot or walking cast for 6–8 weeks Protected weight bearing —graduated progression based on healing Physical therapy —focusing on ankle stability, proprioception, and strength restoration Follow up imaging —ensuring proper healing alignment Surgical Intervention For displaced fractures, significant syndesmotic disruption, or unstable injuries: Fibular fracture fixation —using plates, screws, or intramedullary rods Syndesmotic repair —restoring the ankle's structural integrity Post operative rehabilitation —structured physical therapy for optimal functional recovery Dr. Robert Hoover performs these surgical repairs, guiding patients through careful rehabilitation to restore full ankle stability and function. Prevention: Protecting Your Ankle While you can't prevent all traumatic injuries, you can reduce your risk: Proper footwear —wearing supportive athletic shoes during