The Hip - book
Home » Bones » Tibia and Fibula » Weber C Fractures

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


Related Products

Roll-A-Bout
An alternative to crutches and wheelchairs. The Roll-A-Bout fully supports the lower leg guaranteeing 100% non-weight-bearing.