# A rare double Maisonneuve fracture involving concurrent proximal and distal fibula; Weber type A fracture: A case report

## TL;DR

This paper reports a rare case of a double Maisonneuve fracture involving a Weber type A distal fibula fracture, highlighting successful surgical treatment and recovery.

## Contribution

The first reported case of a double Maisonneuve fracture involving a Weber type A distal fibula fracture.

## Key findings

- Double Maisonneuve fracture with Weber type A distal fibula fracture is extremely rare.
- Proper restoration of fibular length and ankle mortise stabilization led to favorable outcomes.
- Nitinol staples effectively treated the distal fracture without interfering with syndesmotic hardware.

## Abstract

Double Maisonneuve fracture is an extremely rare traumatic condition characterized by simultaneous proximal and distal fibular fractures with syndesmotic disruption. Previously reported cases involved only Weber type B or C distal fibular fractures. To date, no reports have described an associated Weber type A fracture. We report a case of a double Maisonneuve fracture involving a Weber type A distal fibular fracture and describe the clinical course and surgical management.

A 63-year-old man sustained a left lower leg crush injury involving a Weber type A distal fibular fracture, proximal fibular fracture, medial and posterior malleolar fractures, and tibiofibular diastasis. After initial external fixation, definitive internal fixation was performed on postoperative day 9. The Weber type A fracture was treated using nitinol staples, and fibular length restoration was achieved with a foot distractor. The ankle mortise was stabilized using a one-third tubular plate and trans-syndesmotic screws.

Postoperative imaging confirmed adequate fracture reduction and restoration of the ankle mortise. One year after surgery, radiographs and CT showed complete union and maintained syndesmotic alignment. The patient achieved a Japanese Society for Surgery of the Foot (JSSF) score of 90/100, with full range of motion in both the knee and ankle.

Double Maisonneuve fracture with a Weber type A distal fibular fracture is extremely rare. Accurate diagnosis requires careful palpation of the proximal fibula and imaging of the entire lower leg. Favorable outcomes can be achieved through proper restoration of fibular length and stabilization of the ankle mortise.

•This case represents the first report of a double Masonneuve fracture with Weber type A distal fibula fracture.•Accurate diagnosis required imaging of both ankle and entire lower leg, as proximal fibular fractures can be easily missed.•Nitinol staples was effective for the distal fracture, avoiding interference with syndesmotic hardware.•Restoration of fibular length with a foot distractor and a one-third tubular plate resulted in favorable clinical outcomes.

This case represents the first report of a double Masonneuve fracture with Weber type A distal fibula fracture.

Accurate diagnosis required imaging of both ankle and entire lower leg, as proximal fibular fractures can be easily missed.

Nitinol staples was effective for the distal fracture, avoiding interference with syndesmotic hardware.

Restoration of fibular length with a foot distractor and a one-third tubular plate resulted in favorable clinical outcomes.