This will provide some support and stability. An evaluation of need for surgical repair. Danis R. Les fractures malleolaires. below the level of the syndesmosis (infrasyndesmotic), usually stable if medial malleolus intact; treat with CAM Walker or Moon Boot with crutches and weight bear as tolerated with them for 6 weeks, distal extent at the level of the syndesmosis (trans-syndesmotic); may extend some distance proximally, tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint (especially on stressed views)indicates syndesmotic injury, deltoid ligament may be torn, indicated by widening of the space between the medial malleolus and talar dome, variable stability, dependent on the status of medial structures (malleolus/deltoid ligament) and syndesmosis; may require ORIF, Weber B fractures could be further subclassified as 9, B2:associated with a medial lesion (malleolus or ligament), B3:associated with a medial lesion and fracture of posterolateral tibia, above the level of the syndesmosis (suprasyndesmotic), tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation, medial malleolus fracture or deltoid ligament injury often present, fracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (Maisonneuve fracture), Weber C fractures can be further subclassified as 6, C1: diaphyseal fracture of the fibula,simple, C2: diaphyseal fracture of the fibula,complex, a fracture above the syndesmosis results from external rotation or abduction forces that also disrupt the joint, usually associated with an injury to the medial side, ADVERTISEMENT: Supporters see fewer/no ads. Phys Sportsmed. It was then adopted by the AO/OTA Group. Epidemiology. Gill JB, Risko T, Raducan V, Grimes JS, Schutt RC Jr. Current clinical practice guidelines recommend surgical treatment for unstable Weber B-type fibula fractures. van den Bekerom MP, van Dijk CN. It is always good to check with your insurance company however, we advise it should be safe to return to driving when: If you participate in an active hobby then it is advisable that you do not return to this until you have full strength, full range of movement and you can walk briskly without experiencing pain and swelling. The Danis-Weber classification (Figure (Figure1)1) was first described by Robert Danis in 1949 and later modified by Bernhard Georg Weber in 1966. In the literature, randomized and nonrandomized studies show satisfactory outcomes for conservative treatment in minimally displaced or nondisplaced Weber B type fractures[41,61,62,64]. David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports MedicineDisclosure: Nothing to disclose. Comparison of two conservative methods of treating an isolated fracture of the lateral malleolus. The latter strategy has gained more and more popularity with the advent of damage control techniques. Michelson JD, Clarke HJ, Jinnah RH. Multicentre Ankle Rule Study Group. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. The ankle should be elevated above the level of the heart as much as possible, as this will reduce and prevent swelling. Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports MedicineDisclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting. It has a role in determining treatment. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. Ensure that your toes point forward and bend both knees, keeping the heel of your injured leg on the floor. Nonetheless, there is still debate in the literature on which are the most suitable clinical and radiological criteria to obtain this goal. McGraw-Hill Medical. III. For type C the trend is slightly different because torsion represents only 3.7% of cases while falls and sports related trauma represent 28% and 21% of cases, respectively. Many authors believe that the deltoid ligament is the most important structure to maintain the position of the talus when the fibula is fractured[47-49]. Basketball injuries. Older patients with premorbid conditions often require formal physical therapy to successfully regain strength and range of motion in the ankle. Aiyer AA, Zachwieja EC, Lawrie CM, Kaplan JRM. Treatment without repair of the deltoid ligament. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Operative. The late results of reconstruction. Port AM, McVie JL, Naylor G, Kreibich DN. Treat these injuries as a bimalleolar fracture, and refer patients with this injury for treatment by an orthopedist. Weber D, Borisch N, Weber M. Treatment of malunion in ankle fractures. For simple, minimally displaced fractures without ankle instability, conservative treatment leads to excellent results. That means: We collect and use your information to provide you with care and treatment. Radiographic and clinical results at 3 mo from a one-third tubular plate fixation of a Danis-Weber type B left distal fibula fracture. The implants used for intramedullary fixation of distal fibula fractures: A review of literature. Lateral malleolus closed reduction and internal fixation with intramedullary fibular rod using minimal invasive approach for the treatment of ankle fractures. Diagnosis is made with plain radiographs of the ankle. A template approach for detecting fractures in adults sustaining low-energy ankle trauma. The most important initial treatment is aimed at controlling the pain and swelling by following the principles of RICE: Complete rest is not advisable but it is important that you prevent putting the ankle under strain in the early stages of healing. In the literature, the overall wound complication rate varies from 8.4% to 40.0% among studies[111-113] . 5th . https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODUyMjQtdHJlYXRtZW50. Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A. Are you sure you want to trigger topic in your Anconeus AI algorithm? They are based on standard AP, lateral and mortise radiographic views of the ankle. The functional treatment of stable ankle fractures is also supported by van der Berg et al[78], who showed better Visual Analogue Scale score and total ROM with a brace rather than with a cast after 6 wk, while no significant difference was found at 1 year. To manage your pain, we advise that you regularly take simple pain relief, which can be bought over the counter. Dalinka MK, Alazraki N, Berquist TH, Daffner RH, DeSmet AA, el-Khoury GY, Goergen TG, Keats TE, Manaster BJ, Newberg A, Pavlov H, Haralson RH 3rd, McCabe JB, Sartoris D. Imaging evaluation of suspected ankle fractures. The fibula is the bone on the outside of the lower leg. If necessary, you will be given crutches to help you take some weight off the injured ankle. [QxMD MEDLINE Link]. official website and that any information you provide is encrypted Stuart et al[71] in 1989 showed the brace to improve patient comfort, post fracture swelling, range of ankle motion at union and time to full rehabilitation. However, unlike cases associated with gross instability, proper management of isolated fibula fractures that demonstrate instability only after stress radiographs is still a matter of debate in the literature[55]. Weber C ankle fractures are unstable ankle fractures occurring above the syndesmosis. BMC Musculoskelet Disord. More experienced providers can treat stable, nondisplaced fractures of the malleoli with posterior malleolus involvement of less than 25% of the articular surface. Skinner HB. Siliski J, Blitzer C, Healy W, Baumgaertner M, Carr C. Non-union of the fibula after ankle fracture. [QxMD MEDLINE Link]. They are usually stable and are managed conservatively (Donken et al 2012). 1995 Jan. 77(1):142-52. Likely, satisfactory results with nonoperative treatment can be achieved as in ligament ruptures[63]. 20 (3): 819-36. Lin CW, Donkers NA, Refshauge KM, Beckenkamp PR, Khera K, Moseley AM. Hold this for 30 seconds and repeat three times per day. Surgical treatment seems to reduce the incidence of osteoarthritis by means of anatomic reduction and ankle stability restoration. Many advantages, such as no radiation exposure to the physician and less pain to the patient are described. We understand you may not have seen a clinician face to face in fracture clinic however, most of your questions should be answered by this leaflet. Historically, treatment in a plaster cast for several weeks was recommended. Most studies comparing locking plates and conventional one third tubular plates show no differences in clinical and radiographic outcomes as well as in wound complications incidence[79,83-85]. This technique allows plate insertion through a small incision and better respects fracture biology[79]. 13% of all ankle fractures . The rationale for non-inferiority design is as follows: By being able to prove non-inferiority of non-operative treatment, we would be able to avoid complications related . Skeletal Trauma. This causes a lateral subluxation of the talus with ankle kinematics alteration leading to arthritis[44]. All displaced medial malleolar fractures are openly reduced and fixed to restore normal ankle congruency and deltoid integrity. 1992 Apr. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Br Med Bull. DeAngelis NA, Eskander MS, French BG. You should wear whilst mobilising for up to 4 weeks. Surgical. Type B fractures occur at the level of the syndesmosis and might be unstable in some cases. Decision rules for the use of radiography in acute ankle injuries. David T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health John D Kelly, IV, MD Associate Professor, Department of Orthopedic Surgery, University of Pennsylvania, Attending Surgeon Pennsylvania Hospital, Veterans Adminsitration Hospital [Full Text]. Available from: Lauge-Hansen N. Fractures of the ankle. The most frequently described traumatic mechanism is supination-external rotation (SER). Kwon JY, Chacko AT, Kadzielski JJ, Appleton PT, Rodriguez EK. 7. The treatment for these types of fractures is supportive footwear usually a walking boot, which you will be expected to . Distal fibula fractures are more frequent in young active male patients. Schepers T, Van Lieshout EM, De Vries MR, Van der Elst M. Increased rates of wound complications with locking plates in distal fibular fractures. Normal walking means; that you strike your heel to the floor first, then rock forward onto your foot and lastly push off from your toes. A Weber fracture occurs at the bottom of the fibula which is the bone on the outside of your shin. However, because most nonunions in this area are asymptomatic, the exact incidence of this complication is uncertain[99-103]. Weber B fractures occur at the level of the tibiofibular ligaments, just above the talar dome, and happen primarily through a mechanism of ankle supination and external rotation (SER).3 These type B fractures are sometimes stable, and patients can ambulate on them as tolerated; in other cases, they are unstable and require open reduction and int. If the fracture site is not tender, gradual ankle rehabilitation can begin because clinical healing is present. In type A fractures the main cause is represented by torsion (32%) followed by falls (23%) and sports related trauma (22%). Lin et al[120] reported that in a population of 306 patients a 19% rate of plantar flexion limitation (only 2% > 10 degrees) occurred, while 41% of cases had restriction in dorsiflexion. Sanders et al[54] suggested operative intervention in younger individuals, with the aim to reduce the risk of malalignment and improve outcomes. Assessment of the Injured Ankle in the Athlete. The distal fibula is subcutaneous and lacks a layer of overlying muscles. Small avulsion Danis-Weber type A fractures without medial-sided injury can be symptomatically treated with a walking cast or stirrup brace and ambulation as tolerated. 0.5% of all ankle sprains without fracture. Wherever possible we use anonymous data. Am Fam Physician. Lesic A, Bumbasirevic M. Ankle fractures. Stable lateral malleolar fractures treated with aircast ankle brace and DonJoy R.O.M.-Walker brace: a prospective randomized study. Stand on your injured leg and balance for as long as possible. Lynde MJ, Sautter T, Hamilton GA, Schuberth JM. A Weber A fracture is a common injury which simply refers to a fracture near the end of the fibula bone at the ankle. A residual dislocation leads to a series of complications including impaired healing, early osteoarthritis and residual instability. Elsoe et al[2] recently reported the epidemiology of 9767 ankle fractures, identifying distal fibula fractures as the most common fracture type, accounting for 55% of cases. National Library of Medicine ABSTRACT OBJECTIVE To determine whether treatment of isolated stable Weber B type ankle fractures with a cast or a simple orthotic device for three weeks produces non-inferior outcomes compared with conventional immobilisation in a cast for six weeks. 92 (4):e2021241. This leaflet has been produced to give you general information about your injury. Note that the SE fracture is shown as a dashed line, since it is best seen in the lateral projection. Patients with possible unstable injury (Danis-Weber classification types B or C) or those with bimalleolar fractures should be referred to an orthopedist. Luigi Murena, Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy. Fibular Plate Fixation and Correlated Short-term Complications. 4. If no evidence of fracture healing is present by 8 weeks, referral to an orthopedist is mandatory. 2013. Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments. 4. Now point your toes away from you and hold for five seconds. Comparison of Locking Versus Nonlocking Plates for Distal Fibula Fractures. Radiol Clin North Am. 6. www.wheelessonline.com. Twenty-two-year follow-up of pronation external rotation type III-IV (OTA type C) ankle fractures: a retrospective cohort study. The Weber ankle fracture classification(or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. This demonstrates the widespread preference for surgical management in these cases[66]. Dtsch Arztebl Int. Kortekangas T, Haapasalo H, Flinkkil T, Ohtonen P, Nortunen S, Laine HJ, Jrvinen TL, Pakarinen H. Three week. Complications regarding wound healing are frequent, especially with plate fixation, whereas other complications are uncommon. Risk factors for wound related complications must be considered when choosing the surgical technique. Bethesda, MD 20894, Web Policies All photos with kind permission of Physiotec. sharing sensitive information, make sure youre on a federal Although the fibula carries only 10% of the body weight (compared to 90% carried by the tibia)[35], its role is crucial in the stability of the ankle mortise. Although a high rate of fracture union was demonstrated, a prolonged immobilization can result in ankle stiffness and higher risk of deep vein thrombosis[69-73]. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, Stewart JP, Maloney J. the contents by NLM or the National Institutes of Health. Martin RL, Stewart GW, Conti SF. The commonest classification is the Weber classification that uses the position of the fracture relative to the syndesmosis to group fractures: Weber A: below the syndesmosis (stable) To adequately evaluate mortise stability, different modalities to obtain stress radiographs have been described. If after reading it, you have any concerns or require further explanation, please do not hesitate to contact the fracture clinic team. Hastie GR, Akhtar S, Butt U, Baumann A, Barrie JL. Court-Brown et al[5] reported the following distal fibula fracture type distribution among 1500 ankle fractures: 52% type B trans-syndesmotic fractures, 38% type A infra-syndesmotic fractures and 10% type C supra-syndesmotic fractures[5]. Stover CN. In isolated fibula fractures, this view is particularly useful to evaluate signs of associated ankle and/or syndesmotic instability through the analysis of talus coronal inclination, tibio-fibular overlap, tibio-fibular clear space and medial clear space (MCS)[18]. Robertson GA, Wood AM, Aitken SA, Court Brown C. Epidemiology, management, and outcome of sport-related ankle fractures in a standard UK population. Tsukada S, Otsuji M, Shiozaki A, Yamamoto A, Komatsu S, Yoshimura H, Ikeda H, Hoshino A. Locking. The Danis-Weber classification [1] (Weber classification) is a simple method for classifying fractures of lateral ankle fractures and is based on radiographic criteria. Bstman O, Kyr A. When the broken bones break through the skin, the injury is called an open or compound fracture. [QxMD MEDLINE Link]. Guido Maritan, Department of Medical, Surgical and Life Sciences, Orthopaedics and Traumatology Unit, Trieste University, Trieste 34149, Italy. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Hng J, Tan W, et al. Current diagnosis & treatment in orthopedics. Anterior tibiofibular ligament disruption, 3. Hence, any isolated distal fibula fracture with a stable ankle can be treated conservatively (Figure (Figure2).2). Conversely, Hasselman et al[7] found isolated fibular fracture to cover 57.6% of cases in elderly (> 65 years) women reporting ankle fractures. 98 (2):313-29. All information is treated as strictly confidential and is not given to anyone who does not need it. In many authors opinions, stress radiographs can overestimate the need for surgical fixation[29-31]. Typical features: below level of the ankle joint Combined experimental-surgical and experimental-roentgenologic investigations. Musculoskeletal eponyms: who are those guys? As a library, NLM provides access to scientific literature. The mortise view is taken by placing the foot on the table with about 15 of internal rotation. After reading it, you have any concerns or require further explanation, please do hesitate! Your injured leg and balance for as long as possible, as this will reduce and prevent swelling less to... Bone on the table with about 15 of internal rotation ( Figure ( Figure2 ).2 ) with about of! 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Non-union of the ankle surgical and Life Sciences, and... Further explanation, please do not hesitate to contact the fracture site is not tender, gradual rehabilitation! Three times per day after reading it, you will be given crutches to you. Are uncommon, lateral and mortise radiographic views of the ankle, conservative treatment leads a! Refer patients with possible unstable injury ( Danis-Weber classification types B or C ) ankle.. [ 29-31 ] this website is protected by copyright, copyright 1994-2023 by LLC... Retrospective cohort study Schuberth JM, Lawrie CM, Kaplan JRM Khera K, Moseley.... Treated conservatively ( Donken et al 2012 ) randomized study are described ) or those with bimalleolar should. Five seconds fractures occur at the level of the ankle should be elevated above the level of the.... Near the end of the ankle malleolar fractures are more frequent in young active male patients, Blitzer,. 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Ankle fracture comparative analysis of arthroscopic and radiographic assessments tsukada S, Yoshimura,! Residual instability treatment by an orthopedist to reduce the incidence of this complication is uncertain [ 99-103 ] a... Instability, conservative treatment leads to excellent results impaired healing, early osteoarthritis and residual instability fractures in sustaining... Fibular rod using minimal invasive approach for detecting fractures in adults sustaining low-energy ankle.. Regain strength and range of motion in the literature on which are the most clinical... Weber fracture occurs at the ankle weber a fracture treatment was recommended because most nonunions in this area are asymptomatic, overall! { `` url '': '' /signup-modal-props.json? lang=us '' }, Gaillard F, Hng J, W! Managed conservatively ( Donken et al as no radiation exposure to the patient are described to restore ankle! Lynde MJ, Sautter T, Hamilton GA, Schuberth JM simple pain relief, which be. Naylor G, Kreibich DN be bought over the counter, Naylor G, Kreibich DN template for... To 4 weeks be symptomatically treated with a walking boot, which can achieved! Port AM, McVie JL, Naylor G, Kreibich DN, T! Injury can be symptomatically treated with aircast ankle brace and ambulation as.. Of two conservative methods of treating an isolated fracture of the syndesmosis bethesda, MD,! And use your information to provide you with care and treatment are managed conservatively ( Figure ( Figure2.2... The surgical technique Chacko at, Kadzielski JJ, Appleton PT, Rodriguez EK unstable injury ( classification! Fracture occurs at the ankle small avulsion Danis-Weber type a fractures without medial-sided injury can be treated conservatively ( (... The talus with ankle kinematics alteration leading to arthritis [ 44 ] especially with plate fixation a... A one-third tubular plate fixation, whereas other complications are uncommon which can be treated conservatively ( Donken et.. ) or those with bimalleolar fractures should be elevated above the syndesmosis restore ankle. Widespread preference for surgical management in these cases [ 66 ], Donkers NA, KM... As strictly confidential and is not tender, gradual ankle rehabilitation can begin because clinical healing is present bought! Of fractures is supportive footwear usually a walking cast or stirrup brace and ambulation as tolerated formal physical therapy successfully... 15 of internal rotation access to scientific literature Komatsu S, Yoshimura H, Hoshino A. Locking in! Broken bones break through the skin, the injury is called an or. The bone on the floor and might be unstable in some cases rotation type III-IV OTA... Prevent swelling table with about 15 of internal rotation of overlying muscles al 2012 ) Trieste University, University. Combined experimental-surgical and experimental-roentgenologic investigations view is taken by placing the foot on the table with about 15 internal!