The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, 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.
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Classification
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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; treat with CAM Walker or Moon Boot with crutches and weight bear as tolerated with them for 6 weeks
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type B
distal extent at the level of the syndesmosis (trans-syndesmotic); may extend some distance proximally
usually spiral
tibiofibular syndesmosis usually intact, but widening of the distal tibiofibular joint (especially on stressed views) indicates syndesmotic injury
medial malleolus may be fractured
deltoid ligament may be torn, indicated by 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 open reduction and internal fixation (ORIF)
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Weber B fractures could be further subclassified as 9
B1: isolated
B2: associated with a medial lesion (malleolus or ligament)
B3: associated with a medial lesion and fracture of posterolateral tibia
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type C
above the level of the syndesmosis (suprasyndesmotic)
tibiofibular syndesmosis disruption with widening of the distal tibiofibular articulation
medial malleolus fracture or deltoid ligament injury often present
fracture may arise as proximally as the level of fibular neck and not visualized on ankle films, requiring knee or full-length tibia-fibula radiographs (Maisonneuve fracture)
unstable: usually requires ORIF
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Weber C fractures can be further subclassified as 6
C1: diaphyseal fracture of the fibula, simple
C2: diaphyseal fracture of the fibula, complex
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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
History and etymology
This classification was first described by the Belgian general surgeon, Robert Danis (1880-1962), in 1949. It was later modified and popularized by the Swiss orthopedic surgeon, Bernhard Georg Weber (1929-2002), in 1972 2.