The left ankle AP x-ray shows a comminuted fracture of the medial malleolus. The mortise view of the ankle shows a widened syndesmotic space in addition to the medial malleolus fracture.
The lateral ankle x-ray shows a fracture of the posterior malleolus.
![](http://www.emergucate.com/wp-content/uploads/2019/02/Left-ankle-x-ray-AP-view-medial-malleolus-fracture-89x150.jpg)
![](http://www.emergucate.com/wp-content/uploads/2019/02/Left-ankle-x-ray-mortise-view-medial-malleolar-fracture-widened-syndesmotic-space-91x150.jpg)
![](http://www.emergucate.com/wp-content/uploads/2019/02/Left-ankle-x-ray-lateral-view-posterior-malleolar-fracture-80x150.jpg)
These findings on the x-ray should raise suspicion for a higher fibular fracture and that is what this patient had. This specific injury pattern is called Maisonneuve fracture.
![](http://www.emergucate.com/wp-content/uploads/2019/02/Left-leg-x-ray-Maisonneuve-fracture-61x150.jpg)
Maisonneuve fracture is an unstable injury and needs referral to orthopaedician for operative management. Always think of Maisonneuve fracture when an ankle x-ray shows isolated medial malleolus fracture or widening of the medial ankle joint space (indicative of a deltoid ligament rupture) and obtain full length leg x-ray to rule out a higher fibular fracture.