Isolated Weber B Fibular Fracture
Management
Defined by presence / absence of deltoid ligament injury
85% deltoid ligament intact
Deltoid ligament injury
| Examination | Xray | Stress xray |
|---|---|---|
| Tender / bruising medially | Increased medial clear space |
Gravity Stress View - patient lies injured side down with cross table xray - increased medial clear space
Lead gloves / valgus stress / painful |
 |
 |
 |
Weber B / intact deltoid ligament
Management
Weber B / torn deltoid ligament
Bimalleolar equivalent
Management
- ORIF fibular
- ensure medial joint space fully reduced
- may need to open medial joint / removed osteochondral fragments / deltoid ligament
Weber C fracture
Issue
Syndesmosis disrupted
Management
Weber C + syndesmotic injury: ORIF + syndesmosis stabilization
Maisonneuve injury: proximal fibula with open medial clear space
Intraoperative tests
Cotton test
Stress test
Reduction technique
- foot in neutral, clamp across medial and lateral malleolus
- don't reduce in plantarflexion as posterior talus is more narrow
- don't over reduce the joint
- check symmetrical joint space on mortise view
Options
| Screw fixation | Suture button |
|---|---|
|
One or two screws 3 or 4 cortices ? remove |
One or two |
