In Weber B and C fractures the syndesmosis may have been torn (partially or completely). Weber C: above the syndesmosis (unstable).Weber B: at the syndesmosis (possibly unstable).Weber A: below the syndesmosis (stable).The commonest classification is the Weber classification that uses the position of the fracture relative to the syndesmosis to group fractures: ClassificationĬlassification of distal fibula fractures attempts to split fractures into groups by severity. The syndesmosis is a strong ligament that pulls the tibia and fibula together just above the distal tibiofibular joint. This socket is only functional because the tibia (medial and posterior malleolus) and fibula (lateral malleolus) are held together tightly by the syndesmosis. The ankle is a pseudo-ball-and-socket joint the talus is the ball and the distal tibia and fibula act as the socket. They tend to cause fractures that are higher up the fibula and the rotational component of the injury may cause syndesmosis tears. In some cases, inversion coupled with rotation leads to a more complex injury. Avulsion injuries do not involve the syndesmosis and the ankle remains stable. This results in either a pure ligamentous injury (complete or partial tear) or avulsion of the tip of the fibula (the lateral malleolus). A pure inversion injury will result in tension being applied to the supporting soft tissues of the lateral ankle, particularly the lateral collateral ligament. Most ankle injuries occur because of an inversion injury. Pathology EtiologyĪnkle fractures may be the result of a vast array of injuries that range from an inversion injury to a complex high energy trauma sporting injury. inability to bear weight both immediately after injury and during clinical examinationĪn ankle x-ray series (AP and lateral views) is usually all that is needed to make a diagnosis.point tenderness at the posterior edge or tip of the medial malleoulus.point tenderness at the posterior edge or tip of the lateral malleoulus.The Ottawa ankle rules allow evidence-based decision making regarding the need for plain radiographs in patients with a traumatic ankle injury.Ī plain film radiograph is indicated in the setting of trauma if there are any of the following clinical examination findings 1: Most patients present following an episode of trauma with ankle pain, tenderness and an inability to weight bear. Risk factorsĬigarette smoking and obesity are both risk factors for ankle fractures. motor vehicle accident, sporting injury), while older patients present following minor trauma (e.g. Young patients present following injuries in relatively high-energy trauma (e.g. Ankle injuries, like many fractures have a bimodal distribution. Fractures of the Ankle Joint: Investigation and Treatment Options. Goost H, Wimmer M, Barg A, Kabir K, Valderrabano V, Burger C. Evaluation of the Syndesmotic-Only Fixation for Weber-C Ankle Fractures with Syndesmotic Injury. CURRENT Diagnosis & Treatment in Orthopedics, Fourth Edition. Musculoskeletal Eponyms: Who Are Those Guys? Radiographics. Usually associated with an injury to the medial side Weber C fractures can be further subclassified as 6Ĭ1: diaphyseal fracture of the fibula, simpleĬ2: diaphyseal fracture of the fibula, complexĪ fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint Medial malleolus fracture or deltoid ligament injury often presentįracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs ( Maisonneuve fracture) Tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation Weber B fractures could be further subclassified as 9ī2: associated with a medial lesion (malleolus or ligament)ī3: associated with a medial lesion and fracture of posterolateral tibiaĪbove the level of the syndesmosis (suprasyndesmotic) Variable stability, dependent on the status of medial structures (malleolus/ deltoid ligament) and syndesmosis may require open reduction and internal fixation (ORIF) Tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint (especially on stressed views) indicates syndesmotic injuryĭeltoid ligament may be torn, indicated by widening of the space between the medial malleolus and talar dome Usually stable if medial malleolus intact treat with CAM Walker or Moon Boot with crutches and weight bear as tolerated with them for 6 weeksĭistal extent at the level of the syndesmosis (trans-syndesmotic) may extend some distance proximally Below the level of the syndesmosis (infrasyndesmotic)
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