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Weber C Fractures

- 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 Kennedy JG, et al, 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;
                  - Evaluation of the syndesmotic screw in low Weber C ankle fractures.

- 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, in order 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 Kennedy JG, et al, 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 joint;
                 - 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;
                 - Evaluation of the syndesmotic screw in low Weber C ankle fractures.

Ankle mortise stability in Weber C fractures:  Indications for syndesmotic fixation.

The effect of fibular malreduction on contact pressures in an ankle fracture malunion model.

The influence of a diastasis screw on the outcome of Weber type-C ankle fractures.
Ankle fractures involving the fibula proximal to the distal tibiofibular syndesmosis.

Incidence and clinical relevance of tibiofibular synostosis in fractures of the ankle which have been treated surgically

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