Case #3

Case #1

• Acute oblique fracture of the distal fibula with approximately 1 cm override and posterolateral angulation
• Acute distracted fracture of the medial malleolus with approximately 2 cm lateral displacement
• Acute mildly comminuted fracture of the posterior malleolus with approximately 2 cm lateral displacement
• Posterolateral dislocation of the tibiotalar joint
• Marked widening of the distal tibiofibular syndesmosis

• Weber type C fracture
• Ankle dislocation

• While more complex ankle fracture classification systems exist, it is important to at least be familiar with the Weber classification:
  • Weber type A: lateral malleolar fracture below the level of the talar dome – these are typically stable and managed conservatively
  • Weber type B: lateral malleolar fracture with fracture line exiting medially at the level of the talar dome – these are stable if the medial structures are intact: look for widening of the medial clear space (indicating deltoid ligament injury) and widening of the distal tibiofibular syndesmosis
  • Weber type C: lateral malleolar fracture above the level of the talar dome – usually unstable as these are associated with injury to the distal tibiofibular syndesmosis
• Just like the radius and ulna, think about the tibia and fibula as a ring structure. If you see injury in one place (either fracture or joint subluxation) inspect the rest of the ring for additional injuries. If you only see widening of the medial clear space of the ankle mortise, make sure to get tibia/fibula radiographs to look for a proximal fibular (Maisonneuve) fracture

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