In Danis–Weber classification of ankle fractures, which type correlates with injury to the inferior tibiofibular syndesmosis and always requires syndesmotic screw fixation?

• A Weber A — fracture below level of syndesmosis
• B Weber B — fracture at level of syndesmosis
• C Weber B with medial malleolus fracture
• D Weber C — fracture above level of syndesmosis ✓

Explanation

Weber C fractures occur above the level of the inferior tibiofibular syndesmosis, meaning the interosseous membrane and syndesmotic ligaments are disrupted to allow the fibula to fracture that high. This invariably produces syndesmotic instability requiring screws or tightrope fixation to restore the ankle mortise. Weber A fractures are below the syndesmosis and are typically stable; Weber B fractures at the syndesmosis may or may not injure the syndesmosis depending on mechanism, and stress testing under anaesthesia guides screw need.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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