Journal List > J Korean Orthop Assoc > v.43(3) > 1012792

Park, Park, Hahn, Jung, Choi, and Lee: Syndesmosis Injury Associated with the Weber Type B Lateral Malleolar Fracture

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.

Figures and Tables

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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Table 1
Characteristics of Study Cohort (N=81)
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*: Distal tibiofibular distance on radiologic anterolateral view.

Table 2
Algorism of the Diagnosis and Treatment of Ankle Diastasis
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*: Distal tibiofibular distance on the radiologic anterolateral view.

Table 3
Results of the Wagsteffe Fracture
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*: Avulsion distal fibular fracture by the anterior tibiofibular ligament, : distal tibiofibular distance on the radiologic anterolateral view.

Table 4
Clinical Results of Syndesmosis Fixation
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#: paired t-test for an analysis of the final range of motion between the injured ankle and normal ankle of each patient, ##: student t-test for an analysis of the final range of motion between the two groups.

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