A Review of Distal Fibula Fractures
Image 1. Weber classification of distal fibular fractures (courtesy of faculty.washington.edu)
Image 2. Weber classification demonstrated on xray (courtesy of BMJ)
Researchers have also looked at using MRI to evaluate the deltoid ligament to assess for ankle instability. In a study of fifty patients with a distal fibula fracture, an MRI identified multiple deltoid ligament findings. They identified edema within the deltoid ligament, partial tearing, and full thickness tearing of the anterior and posterior deep portion of the deltoid ligament (10). The study found that no patients with a medial clear space <5 mm had a tear of the posterior deep deltoid ligament. This helps support the role of weight bearing radiographs in assessing stability of the ankle.
For nonsurgical clinical assessment, ankle stability is the biggest challenge when seeing a patient with a distal fibula fracture. Research shows that weight bearing radiographs can be used to assess the medial clear space when evaluating for ankle stability. Those patients with medial clear space widening less than 5mm typically do well with non-operative measures.