Weber classification of ankle fractures

Last revised by Ashesh Ishwarlal Ranchod on 15 Jul 2023

The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. It has a role in determining treatment. 

  • type A

    • below the level of the syndesmosis (infrasyndesmotic)

    • usually transverse

    • tibiofibular syndesmosis intact

    • deltoid ligament intact

    • medial malleolus occasionally fractured

    • usually stable if medial malleolus intact; treat with CAM Walker or Moon Boot with crutches and weight bear as tolerated with them for 6 weeks

  • type B

    • distal extent at the level of the syndesmosis (trans-syndesmotic); may extend some distance proximally

    • usually spiral 

    • tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint (especially on stressed views) indicates syndesmotic injury

    • medial malleolus may be fractured

    • deltoid ligament may be torn, indicated by widening of the space between the medial malleolus and talar dome

    • variable stability, dependent on the status of medial structures (malleolus/deltoid ligament) and syndesmosis; may require open reduction and internal fixation (ORIF)

    • Weber B fractures could be further subclassified as 9

      • B1: isolated

      • B2: associated with a medial lesion (malleolus or ligament) 

      • B3: associated with a medial lesion and fracture of posterolateral tibia 

  • type C

    • above the level of the syndesmosis (suprasyndesmotic)

    • tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation

    • medial malleolus fracture or deltoid ligament injury often present

    • fracture 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)

    • unstable: usually requires ORIF

    • Weber C fractures can be further subclassified as 6

      • C1: diaphyseal fracture of the fibula, simple

      • C2: diaphyseal fracture of the fibula, complex

      • C3: proximal fracture of the fibula

        • a fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint

        • usually associated with an injury to the medial side

This classification was first described by the Belgian general surgeon, Robert Danis (1880-1962), in 1949. It was later modified and popularized by the Swiss orthopedic surgeon, Bernhard Georg Weber (1929-2002), in 1972 2.

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Cases and figures

  • Figure 1: Weber classification
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  • Figure 2: Weber classification
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  • Case 1: Weber A
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  • Case 2: Weber A
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  • Case 3: Weber A
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  • Case 4: Weber A
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  • Case 5: Weber B
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  • Case 6: Weber B
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  • Case 7: Weber B
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  • Case 8: Weber B
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  • Case 9: Weber B
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  • Case 10: Weber C
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  • Case 11: Weber C
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  • Case 12: Weber C
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  • Case 13: Weber C
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  • Case 14: Weber C
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  • Case 15: Weber C
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  • Case 16: Weber C with trimalleolar ankle fracture
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