![]() To do this, emergency physicians need to employ stress radiographs to assess the stability of the ankle joint. 3 For this reason, assessing deltoid ligament integrity is of critical importance in determining the stability of an ankle fracture. 5Ĭlinical signs such as medial ankle pain, swelling, and ecchymosis are not reliable in identifying a deltoid ligament injury. 4 In what appears as an otherwise isolated Weber B fibular injury, a tear of the deltoid ligament can be considered “equivalent to a medial malleolar fracture,” qualifying the fracture mechanically as unstable, thus requiring operative management. A talar shift of 1 mm results in a 42 percent decrease in tibiotalar contact area, which can lead to significant increases in contact stress. The deltoid ligament, which runs from the medial malleolus to the calcaneus, talus, and navicular bones, plays a vital role in maintaining correct talus positioning. With Weber B fractures, the stability of the ankle joint depends on injury to the tibiofibular ligaments and the deltoid ligament. ![]() Any bi- or trimalleolar fracture should be considered unstable because of the disruption of the bony architecture on both the medial and lateral side of the joint. Unstable ankle fractures are one of the primary indications for orthopedic referral. In general, most stable ankle fractures can undergo nonoperative management by a primary care physician. The primary consideration regarding need for operative management of a closed ankle fracture is stability. The focus of this article is to help emergency physicians choose the proper method for determining that stability. 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 internal fixation (ORIF). 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). Weber C fractures are almost always unstable and require surgical intervention. Weber C fractures are above the ankle joint and are associated with a syndesmotic injury. Injuries to the distal fibula, below the talar dome, are classified as type A and are stable fractures. Tips for Diagnosing Occult Fractures in the Emergency DepartmentĮxplore This Issue ACEP Now: Vol 39 – No 04 – April 2020.Tips for Catching Commonly Missed Ankle Injuries.Tips for Managing Suspected Occult Fractures.Rest and Elevation: Try to rest the foot for the first 24 to 72 hours to allow the early stage of healing to begin. Apply this to the sore area for up to 15 minutes, every few hours ensuring the ice is never in direct contact with the skin. Harper MC: Ankle fracture classification systems: a case for integration of the Lauge-Hansen and AO-Danis-Weber schemes Foot Ankle. Cold packs: cold pack (ice pack or frozen peas wrapped in a damp towel) can provide short term pain relief.Arimoto HK, Forrester DM: Classification of ankle fractures: an algorithm AJR Am J Roentgenol.Wheeless' Orthopedics: discussion of Weber B fractures.The fracture is seen to arise at the same level of the tibiotalar joint, indicative of a Weber B injury. There is a fibular fracture, near the level of the tibiotalar joint. This results in partial disruption of the tibiofibular ligament complex and is from supination-lateral rotation injury. The Weber B fracture consists of a fracture of the fibula near the joint and a transverse fracture of the medial malleolus (or disruption of the deltoid ligament). The Weber classification is used to determine the severity of tibiofibular ligament injury by the level of fibular fracture.
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