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foot ankle

Ankle Fractures (Weber/AO Classification)

intermediate
6 min
28 marks
6 questions
Clinical Scenario
A 52-year-old woman presents to the emergency department following a twisting injury to her right ankle while walking down stairs. She heard a "crack" and was unable to weight-bear. On examination, there is significant swelling around the ankle with tenderness over both malleoli. The foot is neurovascularly intact. AP, lateral, and mortise radiographs reveal a displaced fracture of the distal fibula at the level of the joint line with a transverse medial malleolar fracture. The medial clear space is widened to 6mm.
AP and lateral radiographs of the ankle demonstrating a Weber B bimalleolar ankle fracture. The fibular fracture is at the level of the syndesmosis (trans-syndesmotic). There is an associated transverse medial malleolar fracture. The mortise view shows lateral talar shift with increased medial clear space (>4mm) indicating deltoid ligament injury or medial malleolar fracture. The posterior malleolus is intact on lateral view.
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AP and lateral radiographs of the ankle demonstrating a Weber B bimalleolar ankle fracture. The fibular fracture is at the level of the syndesmosis (trans-syndesmotic). There is an associated transverse medial malleolar fracture. The mortise view shows lateral talar shift with increased medial clear space (>4mm) indicating deltoid ligament injury or medial malleolar fracture. The posterior malleolus is intact on lateral view.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the classification systems for ankle fractures.

Question 2 (5 marks)

How do you assess stability of an ankle fracture?

Question 3 (6 marks)

Describe the surgical approach and fixation principles.

Question 4 (5 marks)

When do you address the syndesmosis and posterior malleolus?

Question 5 (4 marks)

What are the complications of ankle fractures?

Question 6 (4 marks)

Discuss outcomes and special circumstances.

Exam Day Cheat Sheet

Must Mention

  • •Weber: A (below), B (at), C (above) syndesmosis
  • •Medial clear space >4mm = unstable
  • •SER most common mechanism
  • •Syndesmosis: fix Weber C, stress test Weber B
  • •Posterior malleolus: fix if >25% or unstable
  • •Fix fibula first (restores length/rotation)

Common Pitfalls

  • •Missing Maisonneuve
  • •Not stress testing Weber B
  • •Fixing medial before fibula
  • •Wrong ankle position for syndesmosis
  • •Missing posterior malleolus
  • •Not checking mortise alignment