T&O: Ankle Fractures

Question 1

What classification system is used in ankle fractures?

Answer 1

Weber classification: based on the fibular fracture in relation to the tibiofibular syndesmosis.

Type A, B and C.

Question 2

Describe the features and management of a Weber A fracture.

Answer 2

Features:

• fibular fracture distal to tibiofibular syndesmosis
• syndesmosis intact
• deltoid ligament intact
• medial malleolus occasionally fractured

Management:

• usually stable
• can often be managed conservatively, e.g. POP cast.
• sometimes requires open reduction and internal fixation, esp. if medial malleolus fractured

Question 3

Describe the features and management of a Weber B fracture.

Answer 3

Features:

• fibular fracture level to syndesmosis, or only partially torn
• deltoid ligament may be torn
• medial malleolus may be fractured

Management:

• variable stability
• likely requires ORIF

Question 4

Describe the features and management of a Weber C fracture.

Answer 4

Features:

• fibular fracture proximal to syndesmosis
• tibiofibular syndesmosis disrupted, with widening of distal tibiofibular articulation
• medial malleolus fracture or deltoid ligament injury present

Management:

• unstable
• requires ORIF

Question 5

What is a trimalleolar fracture?

Answer 5

Fracture of:

• lateral malleolus
• medial malleolus
• posterior corner of tibia

Question 6

What is a Maisonneuve fracture?

Answer 6

Combination of:

1. spiral fracture off proximal fibula
2. unstable ankle injury - can manifest radiologically by:
   - widening of ankle joint due to distal tibiofibular syndesmosis and/or fdeltoid ligament disruption OR
   - fracture of medial malleolus

Is caused by pronation external-rotation mechanism.

Question 7

Should Pts with stable Weber A fractures be allowed to weight bear? Why?

Answer 7

Yes. The fracture is stable as the intact deltoid ligament maintains the position of the talo-tibial joint. Weight bearing actually improves healing of the fibular fracture.

Question 8

How can an ankle fracture be identified as stable on x-ray?

Answer 8

Look at medial side of joint: when undisplaced there is a medial clear space of <5 mm. Displaced/unstable if >5 mm.

Question 9

How many ankle fractures are stable? How would you manage these?

Answer 9

70%

No active treatment necessary

• RICE
• ankle brace
• full weight-bearing
• active exercise
• no check x-rays