Weber’s ankle fracture classification (or Danis-Weber classification) is a simple type of classification system for the classification of lateral malleolar fractures, severity, degree of fracture, angle, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. It has a role in determining treatment.
Classification
- type A
- below the level of the syndesmosis (infrasyndesmotic)
- usually transverse
- tibiofibular syndesmosis intact
- deltoid ligament intact
- medial malleolus occasionally fractured
- usually stable if medial malleolus intact
- type B
- the distal extent at the level of the syndesmosis (trans-syndesmotic); may extend some distance proximally
- usually spiral
- the tibiofibular syndesmosis is usually intact, but the widening of the distal tibiofibular joint (especially on stressed views) indicates syndesmotic injury
- medial malleolus may be fractured
- the deltoid ligament may be torn, indicated by a 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
- B1: isolated
- B2: associated with a medial lesion (malleolus or ligament)
- B3: associated with a medial lesion and fracture of the posterolateral tibia
- type C
- above the level of the syndesmosis (suprasyndesmotic)
- tibiofibular syndesmosis disruption with the widening of the distal tibiofibular articulation
- medial malleolus fracture or deltoid ligament injury often present
- the fracture may arise as proximally as the level of the fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (Maisonneuve fracture)
- unstable: usually requires ORIF
- Weber C fractures can be further subclassified as 6
- C1: diaphyseal fracture of the fibula, simple
- C2: diaphyseal fracture of the fibula, complex
- C3: proximal fracture of the fibula
- 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
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The Danis–Weber classification (often known just as the Weber classification) is a method of describing ankle fractures. It has three categories:
- Type A
Fracture of the fibula distal to the syndesmosis (the connection between the distal ends of the tibia and fibula). Typical features:
- below the level of the ankle joint
- tibiofibular syndesmosis intact
- deltoid ligament intact
- medial malleolus occasionally fractured
- usually stable: occasionally nonetheless requires an open reduction and internal fixation (ORIF) particularly if medial malleolus fractured
- Type B
Fracture of the fibula at the level of the syndesmosis. Typical features:
- at the level of the ankle joint, extending superiorly and laterally up the fibula
- tibiofibular syndesmosis intact or only partially torn, but no widening of the distal tibiofibular articulation
- medial malleolus may be fractured or deltoid ligament may be torn
- variable stability
- Type C
Fracture of the fibula proximal to the syndesmosis. Typical features:
- above the level of the ankle joint
- tibiofibular syndesmosis disrupted with the widening of the distal tibiofibular articulation
- medial malleolus fracture or deltoid ligament injury present
- unstable: requires ORIF
Categories B and C imply a degree of damage to the syndesmosis itself (which cannot be directly visualized on X-ray). They are inherently unstable and are more likely to require operative repair to achieve a good outcome. Type A fractures are usually stable and can be managed with simple measures, such as plaster of Paris cast.
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