of the proximal fibula and widening of the interosseous clear space (or tibiofibular clear space). The interosseous clear space is the area between the medial side of the fibula and lateral side of the tibia. 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. If necessary, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) may also be used to clarify diagnosis. MRI scans can check for interosseous membrane or tibial tubercle damage if high instability of the ankle is diagnosed. Arthroscopy may be used to diagnose a syndesmotic lesion but is often not recommended due to operative difficulty. Stress radiographs of the ankle are used to assess the integrity of the deltoid ligament and tibiofibular syndesmosis. The size of the medial clear space can also be measured using stress radiography. Classification A Maisonneuve fracture may be a simple fracture or comminuted fracture: A simple fracture, in the case of a Maisonneuve fracture, only refers to the fibula being broken in one place without any damage being done to the surrounding tissues. A comminuted fracture is when the bone is broken in more than two places. X-ray, CT, or MRI scans can be used to diagnose the extent of the Maisonneuve fracture's damage and determine whether it is a simple or comminution fracture. During diagnosis, a supination-external rotation pattern of injury may also be concluded if there is an isolated fracture of the posterior tubercle of the tibia. Treatment Reduce the proximal fibula and medial malleolus to achieve stabilisation Repair the distal tibiofibular syndesmosis and deltoid ligament Restore ankle mortise stability Treatment can be achieved by either non-operative (or conservative) or operative means. The main operative treatments for a Maisonneuve fracture are open-reduction surgery and closed-reduction surgery, both of which usually preceding internal fixation of the injury. These procedures are known as Open Reduction Internal Fixation (ORIF) and Closed Reduction Internal Fixation (CRIF). Internal fixators Syndesmotic screws are the main, internal fixators used in surgeries for a Maisonneuve fracture. Two main types of syndesmotic screws are used: trans-syndesmotic screws (positioned at the level of the syndesmosis) and supra-syndesmotic screws (positioned above the syndesmosis). Based on several clinical results, syndesmotic screws are recommended to be fixed at least 1 centimetre proximal to the tibiofibular syndesmosis or 4 to 6 centimetres proximal to the tibiotalar joint line. Cadaveric