Study of seventeen cases of Maisonneuve fracture established that there
are five stages in the development of a complete lesion. A strong
external-rotation force with the foot in slight supination is thought to be
responsible for the initial stages; this may change to neutral or slight
pronation in the later stages. This is a severe injury to the ankle, which
includes complete diastasis of the distal tibiofibular syndesmosis and
often rupture of the anteromedial joint capsule and deltoid ligament or
fracture of the medial malleolus. Surgical treatment is necessary in later
stages.