- Discussion:
- Weber C ankle fractures occur above the the syndesmosis and are similar to
PER injuries in
the Lauge Hansen classification:
-
classification:
- C:
fibula fracture above
syndesmosis
- C1
diaphyseal fracture of the fibula, simple
- C2
diaphyseal fracture of the fibula, complex
- C3
proximal fracture of the fibula
- frx above the syndesmotic result from external rotation or abduction forces that also
disrupt the syndesmosis and are usually associated with an injury to medial side;
-
outcomes:
- in the report by JG Kennedy et al (JTO Vol 14, No 5, p 359-366), the authors noted that patients with
low Weber C fractures, there was a clear association between the severity of the fracture
dislocation and a poor outcome;
- talar shift of greater than 1/2 the tibial articular surface is associated with significant
articular and soft tissue comprimise;
- Radiographic Studies
- Operative Technique:
-
postion:
- supine, tourniquet, hip bump, hip seat belt to allow table tilting
- a padded Mayo stand is helpful to help position the thigh in moderate abduction and the knee in flexion (which
places the leg in a lateral position);
- flouro on opposite side of table;
-
lateral malleolar frx:
-
surgical approach for lateral malleolar fracture:
- if a
syndesmotic injury is present, be sure to place the incision more posteriorly, inorder to facilitate
insertion of the syndesmotic screw;
- implant:
1/3 tubular plate and
3.5 mm cortical screws:
-
comminuted frx:
- its essential that the fibula not be plated in a shortened position;
- take an x-ray of opposite ankle inorder to judge exact length of fibula;
-
talocrural angle can be used to asses shortening;
-
plate position:
- transverse frx: are reduced & fixed w/
1/3 tubular plate;
- screws can be eccentrically positioned on each side of frx so that compression occurs when these screws are tightened;
- oblique frx: can be fixed w/
lag screw followed by neutralization plate;
-
medial malleolus fractures:
-
4.0 mm cancellous bone screws, or 4.5 mm cannulated bone screws for the medial malleolar fracture;
-
syndesmotic injury:
- anatomic reduction of both the fibular and the medial malleolus frx will usually restore the stability of the mortise;
- if there is evidence of deltoid ligament disuption but no frx, then syndesmotic fixation is usually required;
- in the report by JG Kennedy et al (JTO Vol 14, No 5, p 359-366), the authors examined the effect of syndesmotic screws in low Weber C fractures;
- low Weber C fractures are defined as being within 5 cm of the jiont;
- 26 patients had ankle ORIF with syndesmotic fixation and 19 had ORIF w/o a syndesmotic screw;
- there was no significant difference between either group using subjective and objective criteria;
Ankle mortise stability in Weber C fractures:
Indications for syndesmotic fixation.
J. Solari et al.
J. Orthopedic Trauma. Vol 5. 1991. p 190-195.
The effect of fibular malreduction on contact pressures in an ankle fracture malunion model.
DB Thordarson MD et al.
JBJS. Vol 79-A. No 12. Dec 1997. p 1809.
The influence of a diastasis screw on the outcome of Weber type C ankle fractures.
HR Chissell, J Jones.
JBJS 77-B, 1995. p 435-438.
Ankle fractures involving the fibula proximal to the distal tibiofibular syndesmosis.
