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Weber A stage 2 fracture
#1
Presentation

Trauma

Patient Data
AGE: 65 years
GENDER: Male

X-RAY
Ankle series
[Image: X-RAY_LEFT_ANKLE_0002_jumbo.jpeg]
Frontal

[Image: X-RAY_LEFT_ANKLE_0003_jumbo.jpeg]
AP mortis

[Image: weber-a-2-fracture_jumbo.jpeg]

There is an infra syndesmotic fracture of the tip of the lateral malleolus. It is a transverse fracture that is minimally displaced laterally.

There is an oblique fracture of the medial malleolus with medial and inferior translation.

It appears to be a Weber A stage 2 bimalleolar fracture.

2 case questions available
Case Discussion
Weber A fractures occur when an adduction force is applied to a supinated foot. The sequence of the events is that this fracture first starts laterally. It starts with avulsion fracture of lateral malleolus at an infrasyndesmotic location. The fracture of the distal fibula is usually oriented transverse since it is a pull-off type fracture. In Weber B type injuries, the distal fibular fracture is oblique or vertical.

The second stage is a push-off fracture of the medial malleolus in an oblique orientation. This makes the fracture unstable because of breaking the ring of the ankle in two places.

Hence, this is a Weber A stage 2 fracture. Stage 2 is extremely uncommon.

References
Goost H, Wimmer MD, Barg A et-al. Fractures of the ankle joint: investigation and treatment options. Dtsch Arztebl Int. 2015;111 (21): 377-88. doi:10.3238/arztebl.2014.0377 -
Skinner HB. Current diagnosis & treatment in orthopedics. McGraw-Hill Medical. (2006) ISBN:0071438335
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