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Back| Classification | Presentation | Relationship with Lauge-Hansen Classification |
|---|---|---|
| Type A | Fracture of the lateral malleolus below the level of the tibiofibular joint, which can be an avulsion fracture of the lateral malleolus or lateral ligament injury; the distal tibiofibular syndesmosis and the triangular ligament are intact. This type is primarily caused by posterior rotational stress. | Equivalent to the posterior-inversion type of the Lauge-Hansen classification |
| Type B | Fracture of the lateral malleolus at the level of the tibiofibular joint, showing an oblique fracture from anteroinferior to posteriosuperior in the coronal plane. About 50% are associated with distal tibiofibular syndesmosis separation, and can also be accompanied by fractures of the posterior malleolus, medial malleolus, or triangular ligament injury. This type is usually caused by a strong external rotational force. | Equivalent to the posterior-external rotation type and anterior-external abduction type of the Lauge-Hansen classification |
| Type C | Fracture of the lateral malleolus above the level of the tibiofibular joint, commonly occurring in the mid to lower third of the fibula, but can also extend to the mid to upper third or even the neck of the fibula, accompanied by distal tibiofibular ligament injury. The medial structures may be injured, resulting in avulsion fracture of the medial malleolus or rupture of the triangular ligament. | Equivalent to the anterior-external rotation type of the Lauge-Hansen classification |
Notes
In 1949, Denis proposed a classification method for ankle fractures and dislocations based on pathology. After 1972, Weber and others improved this classification mainly based on the height of the fibular fracture and its relationship with the distal tibiofibular syndesmosis and the tibiofibular joint, dividing ankle fractures and dislocations into three types: A, B, and C.
Type A, with simple lateral malleolus fractures, is often treated non-surgically. In cases of simple lateral malleolus fractures, initial displacement is minimal, and even if there is displacement, the success rate of manual reduction is very high. After reduction, the fracture is stable, and re-displacement typically does not occur, leading to a good prognosis for treatment. In Type B, isolated non-displaced lateral malleolus fractures that do not involve the medial structures can also be treated non-surgically if the ankle mortise remains congruent. According to AO classification, Types B and C require surgical treatment, except for Type A.
The Weber-Denis classification, combined with the location of the fibular fracture, clarifies the ease of manual reduction and fixation post-reduction, thus allowing for a more reasonable treatment plan. For complex ankle fractures where the integrity of the ankle mortise cannot be effectively restored, this classification illustrates the necessity of surgical treatment, serving as a basis for surgical intervention, and this classification method is simple, easy to remember, and convenient to master.
