Malleolar fracture

Question 1

Weber A (LH)

Answer 1

ASAD

1. talofib ligament or fibular avulsion fracture
2. vertical medial malleolus fracture and impaction of antero-medial distal tibia

Syndesmosis intact

Question 2

Weber B (LH)

Answer 2

BSER AFPM

1. AS anterior syndesmosis
2. FO short oblique fibula fracture AIPS
3. PS posterior syndesmosis or wolkmann
4. MM medial malleolus transverse or deltoid

BPAB MAF

1. MM medial malleolus transverse fracture or deltoid ligament
2. AS anterior syndesmosis
3. FM transverse comminuted fibula fracture above level of syndesmosis

Question 3

Weber C (LH)

Answer 3

CPER MAFP

1. Medial transverse or deltoid
2. anterior syndesmosis
3. lateral short oblique or spiral (ASPI) above syndesmosis
4. posterior syndesmosis or Volkmann

Question 4

Talocrural angle

Answer 4

83° +/- 4° (no more than 2 mm difference with the other side)

Question 5

Algortihm

Answer 5

Not dislocated
Load bearing X ray
if < 4mm medial gap : conservative
if > 4mm medial gap Osteosynthesis

Question 6

Typ A

Answer 6

1/3 tube plate
+/- hooks
+/- trimed

If medial also broken : treat

Question 7

Typ B

Answer 7

Reposition : pull and IR
Lag screw 2.7 or 3.5

If medial broken : look if more than 4mm

Posterior : if less than 25% of surface theoretically no

Question 8

Typ C

Answer 8

Treat fibula first

Question 9

Positioning screw

Answer 9

if Tillaux Chaput : refix
if Lefort Wagstaffe : refix
if anterior syndesmosis broken : transossary suture

Hook test : if > 2 mm : positioning screw
alternative : ER, if > 2mm : positioning screw
Bring in in dorsal extension !!
3 Cortical is sufficient
4 Cortical has the advantage that if it breaks, we can remove it.
By Maison neuve 2 positionning screw.

Remove at 6-8 weeks
if deltoid also broken 10-12 weeks