[1][2] The Maisonneuve fracture is typically a result of excessive, external rotative force being applied to the deltoid and syndesmotic ligaments.

[4][7] Engaging in high-intensity sports or falling over can increase the risk of tearing the deltoid ligament or cause an avulsion fracture of the medial malleolus from external rotation of the foot.

[9] Damage to the deltoid ligament or interosseous membrane can cause haemorrhaging around the surrounding tissues, resulting in a localised oedema.

[8] As the syndesmotic ligaments are responsible for stabilising the ankle mortise and tibiotalar joint, disruption to this syndesmosis can cause a reduction of the space between the distal tibia, fibula, and talus.

[10][11] If a Maisonneuve fracture is left untreated, instability of the tibiotalar joint and deltoid ligament can cause a valgus deformity of the ankle.

[6] Slight or high degrees of plantarflexion prior to supination-external rotation of the foot have been identified in patients with proximal fibular fractures.

[12] Ankle instability is often associated with a damaged proximal fibula in a Maisonneuve fracture, so patients are typically asked about the mechanism of injury.

A peer-reviewed study, published in Injury in 2004, found that an interosseous clear space greater than 10 millimetres indicates diastasis of the syndesmotic ligaments.

MRI scans can check for interosseous membrane or tibial tubercle damage if high instability of the ankle is diagnosed.

[4][15] Cadaveric analyses, from a comparative study published in Foot & Ankle International in 1997, suggest that screw fixation at 2 centimetres proximal to the tibiotalar joint line is also adequate.

[4][6][13] In cases where only the posterior ligaments of the tibiofibular syndesmosis are partially damaged, non-operative treatment such as long-leg casting for at least 6 weeks is recommended.

To reduce the fibula and restore the ankle mortise to its proper anatomical configuration, partial dorsiflexion of the foot is maintained prior to intraoperative screw fixation.

[6] That is, the posterior hinge of the ankle is still stable, and the foot can be internally rotated using traction to restore fibular bone length.

[12] It is generally recommended that medial malleolar fractures do not require surgical intervention if closed reduction is sufficient for the restoration of bone length.

[7] Complications that may postoperatively occur include: Incorrectly positioned screws can potentially make contact with articular surfaces, which can cause calcification around the affected area.

[4] Postoperative follow-ups are done to ensure that treatment has produced satisfactory results, such as checking if malreduction of any of the associated structures in a Maisonneuve fracture has occurred.

[4][9] Exact incidence rates are unknown, but it is believed that the Maisonneuve fracture accounts for 5% of all ankle injuries treated in surgery.

A clinical article on studies conducted between 2014 and 2019, published in Orthopaedic Surgery in 2020, reported that 78% of admitted patients with a Maisonneuve fracture were male.

[4] Comorbidity of the Maisonneuve fracture and other health conditions, such as hypertension, obesity, and psoriatic arthritis, have been identified in patient medical histories.