Ankle fracture: Weber B3

Case contributed by Abeer Ahmed Alhelali

Presentation

History of trauma.

Patient Data

Age: 35 years old
Gender: Male
x_ray

Comminute fracture in the distal shaft of fibula with intra-articular extension.

Minimal lateralization of talus is noted.

ct

Mildly displaced trimalleolar fracture with mild lateralization of the talus suggesting ligamentous injury. The lateral malleolar fracture begins at the syndesmosis extending obliquely into the proximal part of the distal fibula.No widening of the distal syndesmosis.

No other fracture seen. Soft tissue edema and hematoma around the fracture site.

Findings are consistent with Weber B3.

Case Discussion

Weber ankle fracture is an easy system to classify lateral malleolar fractures in relation to the ankle joint.

Classification:

Type A: below the level of the talar dome. Tibiofibular syndesmosis intact. Usually stable if medial malleolus intact.

Type B: distal extent at the level of the talar dome & may extend some distance proximally. tibiofibular syndesmosis usually intact but widening of the distal tibiofibular joint may be seen. Variable stability. Subtypes:

  • B1: isolated
  • B2: associated with a medial lesion in (malleolus or ligament) 
  • B3: associated with a medial lesion and fracture of posterolateral tibia (as in our case)

Type C: above the level of the ankle joint with disruption of tibiofibular syndesmosis with widening of the distal tibiofibular articulation.Unstable: usually requires ORIF. Subtypes:

  • C1: simple diaphyseal fracture of the fibula
  • C2: complex diaphyseal fracture of the fibula
  • C3: proximal fracture of the fibula

Special thanks to Dr. Mohamed Ashfaque Kukkady.

 

 

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