Concurrent proximal and distal fibular fracture with twisting ankle injury: a ‘Double Maisonneuve’ case report

Background: Ankle fractures are a commonly encounter orthopaedic injury, with lateral malleolar fractures being the most common fracture pattern seen. Proximal fibular fracture with ankle twisting injuries, termed the Maisonneuve fracture, are much rarer, and are thought to account for 5% of surgical treated ankle fractures. Fracture of both proximal and distal fibular following twisting ankle injury is an extremely rare occurrence, with little reported cases in existing literature. Case presentation: We present one such case of a 45-year-old male who sustained both a proximal and distal fibular fracture following a twisting ankle injury with associated posterior malleolar fracture and anterolateral distal tibial tubercle (Tillaux-Chaput fracture). Both proximal and distal fractures were identified on presentation, and he underwent open reduction internal fixation with single cortical screw fixation of anterolateral distal tibial tubercle, lag screw to lateral malleolar and neutralization plate, and two tricortical syndesmotic screws. His post operative course was unremarkable, and he returned to work after nine weeks. Conclusion: Concurrent proximal and distal fibular fractures following ankle twisting injury is an extremely rare fracture pattern. This case highlights the necessity for thorough physical examination and radiological imaging for all ankle injuries while also highlighting the importance of preoperative computed tomography on surgical planning for ankle fractures.