On the left a patient with an extraarticular distal radius fracture. In daily practice most use the Weber system, which is easy to memorize, while the Lauge-Hansen seems rather difficult at first glance. distal radioulnar joint (Galeazzi fracture-dislocation) lunate / perilunate dislocation; associated ligamentous injury. The talus rotates externally and moves laterally because it is free from its medial attachment.Continuous force will twist the fibula and displace it distally, while proximally it is fixed to the tibia.Here we see the different stages in the axial plane.We do not see a tertius fracture, which would indicate stage 4, but there may be a rupture of the posterior syndesmosis.Here an example of a Weber C fracture with a proximal fibula fracture.
C1: diaphyseal fracture of the fibula, simple; C2: diaphyseal fracture of the fibula, complex; C3: proximal fracture of the fibula. However, it is more important to recognize what makes the fracture more severe: oblique, spiral or comminuted configuration; greater degree of angulation ; intra-articular involvement; additional fractures. oblique: an oblique line across the bone; spiral: looks like a corkscrew; comminuted: more than 2 parts to the fracture; incomplete: the whole cortex is not broken. Usually there is a total rupture of the syndesmosis with instability of the ankle.Weber B starts anterolaterally and the sequence is:Another important thing to remember is, that a ligament can rupture or cause an avulsion fracture at the insertion. Young patients present following injuries in relatively high-energy trauma (e.g. Fractures with this configuration frequently show loss of reduction at follow up and need surgical treatment.
Radiology department, Rijnland Hospital Leiderdorp, the Netherlands.
In some cases, inversion coupled with rotation leads to a more complex injury. The sequences in a Weber B fracture or Lauge-Hansen supination exorotation injury take place in a clockwise manner:Immediately after the injury the injured parts may again align, which can make it difficult to detect the injuries.These images show another typical Weber B fracture stage 4.Weber C is seen in approximately 20% of ankle fractures. Oblique fractures are particularly prone to angulation in the plane of the fracture. The commonest classification is the Weber classification that uses the position of the fracture relative to the syndesmosis to group fractures:In Weber B and C fractures the syndesmosis may have been torn (partially or completely). Remember that avulsion injuries may be small, and just involve the tip, or the internal surface of the malleolus.Once you have seen the fracture, remember to describe:The joint spaces around the talus should be the same all the way around. When a fracture is oblique or when it is comminuted with crossing of the mid axial line, it can be unstable. The syndesmosis is a strong ligament that pulls the tibia and fibula together just above the distal tibiofibular joint.Ankle fractures may be the result of a vast array of injuries that range from an inversion injury to a complex high trauma sporting injury. If they are not and the talar dome is not parallel to the tibial plafond, the syndesmosis has been torn. According to Lauge Hansen we are probably dealing with: Finally the posterior syndesmotic ligament ruptures, or there is an avulsion of the posterior malleolus, also known as posterior malleolus fracture (red arrow).The medial clear space is only slightly widened, but based on the stages of Lauge Hansen there must be a collateral band rupture.Start with a first impression and look for fractures and signs of ligamentous rupture. This results in widening of the distal tibiofibular joint and loss of integrity of the socket.The AP and lateral views from an ankle x-ray will almost always allow detection of a lateral malleolar fracture. On the right image the medial malleolus is pulled off by the medial collateral ligament due to pronation of the foot. Notice that the fibular fracture is transverse, because it is an avulsion or pull-off fracture. However, more severe injuries with ligamentous injury and ankle instability may require operative reduction and internal fixation.In most cases an ankle x-ray is all that is required for diagnosis and follow up. Now re-examine the films to make sure that you do not overlook a higher grade ankle injury.In the final report the fracture is described according to Weber and/or Lauge-Hansen. This is called talar shift and the ankle joint is unstable.
An oblique or vertically oriented fracture indicates 'push-off'. Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach Classification of ankle fractures is important in order to estimate the extent of the ligamentous injury and the stability of the joint.Basically there are three main types of ankle fractures.These fractures are identical to the fractures described by Lauge-Hansen as supination-adduction, supination-exorotation and pronation-exorotation.Once you understand the trauma mechanism as described by Lauge-Hansen and the sequence of events that take place in stages, then you know where to look for fractures and ligamentous injuries.This is a transsyndesmotic fracture with usually partial - and less commonly, total - rupture of the syndesmosis.This is a fracture above the level of the syndesmosis. Cigarette smoking and high BMI are both risk factors for ankle fractures.Ankle injuries, like many fractures have a bimodal distribution. If they are not and the talar dome is not parallel to the tibial plafond, the syndesmosis has been torn. Transverse fracture example - Tibia Hover on/off image to show/hide findings scapholunate dissociation; … Stage 2 - Oblique fracture of the medial malleolus.
Like transverse fractures, the term is predominantly used in the context of describing a fracture in a long bone.
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