Webber Ankle Injury Classification
A: In a Supination-Adduction injury the fibula breaks first, with a fracture below the level of the mortise (Danis-Webber A). In more severe cases the tibia also breaks through the medial malleolus, and once both malleoli are broken the joint becomes unstable and the talus can shift inside the mortise.
B: In Supination External Rotation injury the fibula breaks at the level of the mortise (Danis-Webber B). The fibula breaks first, the next injury (with increasing severity) is either a fracture of the medial malleolus OR a deltoid ligament is tear. Because a deltoid ligament injury is not seen on plain radiographs, an unstable injury can appear to be a stable one on a standard (i.e. non-stress) mortise view. The quick and easy way to differentiate these two are via stress view of the ankle.
C: In Danis-Webber C the fibula fracture is above the level of the mortise. These injuries are caused by pronation and external rotation. They arealmost all unstable injuries. The fibula breaks after injury to the medial malleolus or deltoid ligament. Although you can safely assume that the injury is unstable, a stress view is still useful to document the degree instability.
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