J Korean Orthop Assoc.  2008 Jun;43(3):359-365. 10.4055/jkoa.2008.43.3.359.

Syndesmosis Injury Associated with the Weber Type B Lateral Malleolar Fracture

Affiliations
  • 1Department of Orthopedic Surgery, Korea University College of Medicine, Anam Hospital, Seoul, Korea. soonlee@kumc.or.kr

Abstract

PURPOSE: We evaluated the syndesmosis instability associated with Weber type B lateral malleolar fractures.
MATERIALS AND METHODS
Eighty one Weber type B lateral malleolar fractures were evaluated and classified according to the radiologic criteria. Syndesmosis instability was checked with a hook test during operation. The radiological and clinical results were assessed.
RESULTS
Twenty two cases were associated with a widening of the distal tibiofibular distance. Sixteen (73%) had syndesmosis instability confirmed with a hook test and were fixed with a syndesmotic screw. Eight (66%) out of 12 Wagstaffe fractures were fixed with a syndesmotic screw due to the instability. The distal tibiofibular distance was 7.4+/-2.4 mm, 4.6+/-1.9 mm and 4.9+/-1.9 mm preoperatively, postoperatively, and at the final follow up, respectively. All cases achieved union and good clinical results with more than 85 on the AOFAS score were obtained.
CONCLUSION
Weber type B lateral malleolar fractures can be associated with a syndesmosis injury. An intraoperative hook test should be carried out for accurate diagnosis. Considerable attention needs to be paid to Wagsteffe fractures, because of the high probability of combining syndesmosis instability.

Keyword

Ankle; Syndesmosis; Fracture; Instability

MeSH Terms

Animals
Ankle
Follow-Up Studies

Figure

  • Fig. 1 Weber type B fracture with a syndesmosis instability. (A) Preoperative ankle radiograph shows a Weber type B ankle fracture with an avulsion fragment of the distal fibula by the anterior tibiofibular ligament. The preoperative distal tibiofibular clear space was measured to be 6.5 mm. (B) Preoperative ankle MRI shows a rupture of the intramembranous ligament between the distal tibia and fibula (arrow). (C) Ruptured anterior tibiofibular ligament (arrow) was detected during surgery. (D) Postoperative radiograph show internal fixation of the ankle fracture and syndesmosis screw fixation.


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