Weber-B lateral malleolus fracture: an imaging case review

Abstract

A 69-year-old male presented to a chiropractic clinic four days post-injury with lateral ankle pain and swelling. Using the Ottawa ankle rules as a guideline for the need for radiographs, this case was deemed necessary for x-ray evaluation. The radiographic examination demonstrated a Weber B fracture of the distal fibula with a noted widening of the medial clear space of the ankle, which indicated the additional lesion of the deltoid ligament. This patient was referred to an orthopedist to have an open reduction and internal fixation (ORIF) surgery.

Keywords: Ottawa ankle rules; Weber classification; diagnostic imaging; fibula; fracture.

Figure 1

Clinical images taken two days post-injury. There is moderate soft tissue swelling of the left ankle that extends into the toes. There is also bruising at the lateral aspect of the foot and the area around the metatarsophalangeal joints.

Figure 2

AP, Lateral, and Medial Oblique left ankle radiographs taken four days post-injury revealed a spiral, non-comminuted, distal fibular fracture, which extends to the level of the tibial plafond. Slight lateral translation was noted without evidence of angulation, rotation, or distraction. Concomitant soft tissue swelling about the ankle.

Figure 3

AP gravity stress view of the left ankle revealed a 2 mm lateral translation of the distal segment of the fibula. Increased clear space at the medial aspect of the ankle was evident, which denoted deltoid ligament instability.

Figure 4

AP, Lateral, and Medial Oblique left ankle radiographs taken one-week post-surgery (18 days post-injury) revealed the fixated fracture. An Arthrex titanium plate was placed on the distal fibula. An interfragmentary screw was placed first to join the two segments, then a combination of cortical screws, distal locking screws, and proximal locking screws were used to secure the plate, totaling 10 screws. The skin was closed with staples – 18 of which can be seen in the radiograph.