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DICOM HelpSource: Local (us-east1-c)
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Demographics:
14 years old, Male
Indication:
Ankle injury
Findings
- Acute minimally displaced oblique fracture of the distal fibula with fracture line at the level of the tibial plafond medially
- Soft tissue swelling about the ankle
Diagnosis
Weber type B fracture
Sample Report
Acute minimally displaced oblique fracture of the distal fibula with fracture line at the level of the tibial plafond medially (Weber B).
Ankle mortise is congruent.
Soft tissue swelling about the ankle.
Discussion
- 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
Annotated Images & Illustrations
Red arrows: oblique fibular fracture with fracture line exiting at the level of the talar dome medially (Weber type B).