Maisonneuve’s sign is hyperextension of the wrist observed in Colles’ fracture, resulting from posterior displacement of the distal radial fragment. It is a clinical indicator of distal radius fracture with dorsal angulation.

Pathophysiology

Normal physiology:

• The wrist normally maintains neutral alignment at rest, with the distal radius articulating properly with the carpal bones.

Abnormal physiology (Colles’ fracture):

• A fall on an outstretched hand can fracture the distal radius.

• Posterior (dorsal) displacement of the distal fragment leads to automatic hyperextension of the wrist due to altered mechanics of the wrist joint and tension in the flexor and extensor tendons.

• Hyperextension serves as a visible sign of the dorsally angulated distal radius fracture.

Associated findings: Swelling, pain, tenderness, deformity (“dinner fork” or “bayonet” appearance), and limited range of motion.

Examination Technique

• Patient positioning: Seat or support the patient with the forearm resting on a flat surface.

• Observation: Inspect the wrist for posterior angulation and hyperextension relative to the forearm.

• Palpation: Assess tenderness along the distal radius, swelling, and possible crepitus.

• Documentation: Note degree of hyperextension, deformity, laterality, and associated soft tissue injury.

Clinical Features

Differential Diagnosis

Special populations

Elderly:

• Higher risk due to osteoporosis, fractures may occur with minimal trauma.

Children:

• Growth plate involvement (Salter-Harris fractures) must be considered; deformity may differ from adult presentation.

Limitations

• Subtle hyperextension may be missed in mild fractures or minimally displaced fragments.

• Swelling and pain may obscure deformity.

• Radiographic confirmation is essential; clinical observation alone is not sufficient for diagnosis.

Patient counseling

• Explain that wrist hyperextension indicates a fracture of the distal radius requiring evaluation.

• Recommend immobilization, radiographs, and orthopedic consultation.

• Advise pain management, elevation, and monitoring for neurovascular compromise.

• Discuss healing time and physiotherapy to restore wrist function after fracture stabilization.

Conclusion

Maisonneuve’s sign is a clinical indicator of distal radius fracture (Colles’ fracture) with posterior displacement, manifested as wrist hyperextension. Recognition aids early diagnosis, immobilization, and orthopedic management, preventing complications such as malunion or impaired wrist function.

References

1. Rockwood CA, Green DP, Bucholz RW, Heckman JD. Rockwood and Green’s Fractures in Adults. 9th ed. Philadelphia: Wolters Kluwer; 2020.

2. Court-Brown CM, McQueen MM. Fractures of the Distal Radius. N Engl J Med. 2013;368:2276–2283.

3. Chapman MW. Fractures of the Distal Radius and Ulna. In: Chapman MW, ed. Fractures. 4th ed. Philadelphia: Lippincott; 2012.

4. Maisonneuve N. Traité des fractures et des luxations. Paris: JB Baillière; 1840.