Ankle fractures: pronation-external rotation mechanism

Case contributed by Dr Bruno Di Muzio


Injury with pronation and exorotation of the right foot.

Patient Data

Age: 20-year-old
Gender: Male

Ankle radiographs

There is avulsion of the medial malleolus, fracture of the posterior tibial malleolus, and fibula comminuted fracture above the level of the syndesmosis. Possible rupture of the anterior syndesmosis.

When these ankle injury types are seen, further imaging of the entire fibula is recommended to assess for an accompanying proximal fibular shaft fracture.


Ankle radiographs

No evidence of proximal fibular fractures. 


Ankle radiographs (follow-up post treatment)

The patient underwent open reduction and internal fixation of the Weber C injuries, lateral plate fixation and cortical screw through 3 cortices for syndesmotic fixation (fractured screw). 

Case Discussion

Pronation-external rotation injury mechanism of the ankle causes unstable injuries, including a Weber C fibular fracture, that need surgical reduction/fixation.

Check more on the Lauge-Hansen classification system, which is used for the classification of the ankle injuries based on the mechanism.

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Case information

rID: 48161
Published: 23rd Oct 2016
Last edited: 14th Aug 2019
Tag: rmh, weber c
Inclusion in quiz mode: Included

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