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Comminuted Weber C Fractures

- Discussion:
    - comminuted frx of fibula tend to result from high energy injures resulting from direct lateral trauma or vertical loading;
    - associated injuries include:
           - impaction frx of lateral tibial plafond;
           - metaphysis of tibia (Pilon frx);
           - medial malleolus;
    - w/ these frx it is important to have x-ray of opposite &, uninjured ankles as a template.
           - comminution makes it difficult to judge rotation and length;
    - associated medial malleolar frxs, should be stabilized first to guide reduction of the fibula;
    - w/ minmal comminution, consider lag screw fixation;
    - w/ significant comminution, consider indirect reduction techniques & then spanned w/ plate using screw fixation proximal and distal to frx site;

- Reduction:
    - provisional K wire is placed from fibula into talus or into tibia;
    - a plate is contoured to span the area of comminution;
    - plate along posterior surface of fibula allows thicker, stronger plate to be used w/ less risk to the overlying soft tissues;

- Indirect Reduction:
    - used for type C fibular frx w/ comminution;
    - contour plate and attached plate distally & controlled proximally w/ clamp;
    - bone spreader is levers against a more proximal, temporary screw;
        - this will push distal fragment into a reduced position & restore fibular length;
        - comminuted fragments are teased into place;
        - plate is then attached proximally