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BACKGROUND: Maisonneuve fractures are most commonly characterised by a specific pattern with a medial malleolar fracture or deltoid ligament rupture, a disruption of the ankle syndesmosis ligaments and a fracture of the proximal fibula. CASE DESCRIPTION: We hereby describe for the first time two cases of conservative therapy of Maisonneuve fracture with intact medial structures and with associated posterior malleolus fracture. Patients were assessed with ankle radiographs and magnetic resonance imaging (MRI). The distal fibula was anatomically positioned in its notch and the deltoid ligament and interosseous membrane (IOM) were intact. In addition, the posterior malleolus fracture was not associated with talar subluxation or articular impaction, and the mortise remained anatomically positioned on the initial radiographs. Based on clinical and imaging evaluations, the decision was made to follow conservative treatment. Follow-up showed stability criteria on standing radiographs, and their evolution was clinically uneventful with a good AOFAS score after 1 year. CONCLUSIONS: The discussion emphasized the scarce description of conservative therapy of Maisonneuve fractures for which surgical treatment is considered to be the gold standard. The good results of these two cases are in favour with conservative therapy, avoiding adverse events and complications related to surgery, and showed that conservative therapy should be also considered as an effective therapeutic option in selected cases. We also emphasize that the results of our two cases are, moreover, in favor of an early weight-bearing protocol.