An evaluation of the Weber classification of ankle fractures
Introduction
Malleolar fractures of the ankle are common injuries1, 2. Various classification systems exist to describe these injuries, including those of Lauge Hansen[3]and Müller. Although these systems are useful, the complex nomenclature of the numerous subgroups has precluded them from widespread use[4]. Perhaps the most common ankle classification used is that of Weber, which is based on the level of the fibular fracture relevant to the tibio-fibular syndesmosis[5].
Whilst the treatment of ankle fractures is based largely on radiographic findings, effective strategies for treating ankle fractures will require a classification system that is not only descriptive, but can aid in predicting the outcome following treatment modalities. The purpose of this study was to evaluate the Weber classification as a prognostic indicator in terms of functional and radiographic outcome.
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Materials and methods
One hundred and seventy patients with ankle fractures were culled from the hospital data base, of which 107 were available for follow-up. All fractures which were open or were associated with hindfoot or midfoot injuries were excluded from the study. Fractures with unfused physes and pilon type fractures were similarly excluded. All fractures were treated in the same institution using standard AO/ASIF principles[6].
All patients were evaluated clinically, radiographically and with the use of a
Results
Of the 96 patients available for follow-up, the mean age was 47 years (range 17–76). Eighty-eight ankle fractures could be classified using the Weber system, the remaining eight, all medial malleolar fractures were included in the modified classification system.
Using the Weber classification system there were significantly more of the type B fracture than either of the other two groups (Table 1). No correlation was found between overall outcome score and the level of fibular fracture (Table 1).
Discussion
The first modern classification of ankle fractures has been attributed to Ashurst and Bromer in 1922 and was based largely on the mechanism of injury[12]. This was subsequently augmented by the Lauge-Hansen classification in 1948, which has remained in use today. Despite its usefulness in describing the mechanism of injury, it is difficult to reproduce and its clinical relevance is limited by variable intraobserver reliability4, 13. The more complex anatomical classification of Müller, a
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