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The Oblique Fractures Of The Distal Fibula


Address for Correspondence




We have retrospectively reviewed the medical records of one hundred and sixty five patients with the clinical diagnosis of ankle fracture. In eighty-six of them, we found in the distal fibula three different types of oblique fractures. On the basis of the location of the line of fracture and its spatial orientation, our patients could be grouped as follows: In 23% (20/ 86) of the x-rays, the oblique line of fracture begun below the syndesmosis (Type A) . Type B fracture (at the syndesmosis) was present in 70% (60/86). The line of fracture was above the syndesmosis in 7% (6/86) of the patients (Type C). These findings clearly indicate that, in the distal fibula the line of fracture can be located below ,at level or above the syndesmosis and still have an oblique spatial orientation.

KEY WORDS: Weber Classification, Fractures. Ankle, Stability criteria

J.Orthopaedics 2004;1(3)e2


The oblique fractures of the distal part of the fibula, without medial lesion, are the most common ankle fracture. They exhibited an oblique fracture line, began anteriorly at level or below the fibula anterior tubercle and below at level or over the syndesmosis. The fracture line goes toward hind in approximately a third of diameter of the bone and it spreads in anteriorposterior and distal proximal in relationship to the old axis of the fibula in angle of some 45 grades approached with or without rupture of the inferior tibiofibular ligament (Schaffer and Manoli,1987).Have received several denominations such as: supination - external rotation stage 2 (SE-II) (Lauge Hansen 1954),B (Weber 1966) ,B1 (Müller et al 1990) and oblique short (Harper 1983,1995) . This study is intended to review this type of fracture in The Universitary Hospital of Los Andes (Merida.Venezuela).


We found that the mean age of the patients with short fibular fracture was 37.1 years (range 18 to 87); there were 49 men and 37 women. Between 20 to 49 years old, the men to women ratio was 1.6 (42/26), and in more than 50 years old the woman to men ratio was 1.6(11/7) .On the basis we have retrospectively reviewed the medical records of 165 patients who were seen at the University of Los Andes Hospital in Merida Venezuela, between 1989 and 1994, with the clinical diagnosis of ankle fracture. Eightysix(52%) of them had an oblique trace fracture in the distal fibula without medial lesion. The x-rays were taken in standard views (Bohlin 1961). In all of them, there was evidence of a closed epiphysis. We classified the ankle fractures according to the site of the fibula injury, within the distal syndesmosis, and the likelihood of displacement of the fracture segments. (Type A : horizontal fracture located a the level or below the syndesmosis, Type B : fracture that begins at the level of the syndesmosis and goes obliquely and posteriorly, Type C : an oblique fracture above the syndesmosis (Weber 1966,Müller et al 1991). Particular attention was paid to the spatial orientation of the line of fracture and to the stability of the ankle mortise (Table 1). On the basis of the latter, the fractures were considered to be stable or unstable. In the lateral views, we also measured the length of the fracture line.


According to Lauge- Hansen’s expriment(1954,1959) ,Weber ‘s(1966) and Müller et al(1991) ankle fracture classification is whether location of the line of fracture, sex, stability criterion’s, and the long of its spatial orientation, our patients could be grouped as follows: In 23% (20/ 86)of the x-rays, the oblique line of fracture begun below the syndesmosis and58% (14/24) of the sex masculine (Type A) (Figure 1). Type B fracture was present in 70% (60/86) and prevailed in the female sex in a 52% (27/52)(Figure 2). The line of fracture was above the syndesmosis in 7% (6/86) and they affected both sex (Type C) (Figure 3). .We considered to be stable 91%of the fractures, in the C Type the 83% were stable (Table 2). The line of fracture was long oblique or spiral in its spatial orientation in 38% of the xrays (Figure 4), the remaining of the x-rays showed that only 62% of the lines of fracture were short oblique (Table 2).


Table 1




Medial clear space

Less than 4mm

Mortice view

Syndesmosis A

Less than 5mm

AP view

Syndesmosis B

Less than 10mm

AP view

Syndesmosis C

Less than 1mm

Mortice view

Lateral Malleolus

Less than 2mm

Mortice view

Talar tilt

Less than 2mm

Mortice view

CRITERIONS OF STABILITY (De Souza and Forester 1974, JOY


Table 2




Short Oblique

Long Oblique





















Relationship between criterions of stability and longitude of the fracture trace












Figure 1

In this mortise view the arrow indicates that the long oblique fracture begins below the syndesmosis and the fracture is therefore stable














Figure 2

In this patient the short oblique line of the fracture (arrow) is at the level of the fibular anterior tubercle and again the fracture is stable













Figure 3

The short oblique trace of the fracture is above them syndesmosis (thin arrow), and instability of the fracture is obvious (a medial clear of more than 4 mm is present. (Thick arrow).













Figure 4

Spiral oblique long fracture of the fibula, a medial clear of more than 4 mm (thick arrow) and displacement of the lateral malleolus are present however the syndesmosis is preserved (thin arrow)




The isolated fractures of the distal fibula have been considered the most frequent fracture of the ankle (Harper 1995) and they represent between 10% at 40% of all of them (Lindjô 1981, Ryd and Bengtsson 1992). Mainline the male sex but with more fracture in women older than 50 years old (Benger et al 1986, Daly et al 1987, Desouza et al 1985). All of this is similar to our result in the present paper.

the oblique distal fibular fracture is always located at the level , or above the tibiofibular syndesmosis. In the present study, we found that 28% of the oblique traces were below the syndesmosis. Earlier clinical and experimental studies support our findings (Cedell (1967),Pankovich (1979) Schaffer and Manoli (1987) and Stiehl (1992). In these investigations, the line of fracture begun below the level of the articular line and may occur without any rupture of the anterior tibiofibular ligament.

The fracture trace, short oblique or a longer or spiral, does not have a clinical decisive importance, since most of these fractures are stable and for this reason the criterion’s of treatment are not altered for the longitude of trace.

Another very important aspect of Weber’s (1966) and Müller et al (1991) classification concerns the stability of Type C fractures. We found that, 83% of oblique fractures above the syndesmosis with no medial injury, were stable as previously reported by De Souza and Forester(1974), Monk (1969) and Pankovich (1978, 1979).

The fact a group of these fractures like unclassifiable in the Weber andMüller et al system could exist , the short fibular fracture below the syndesmosis and the C and C1 stable, and the difficulties than we and another(11,16) met with this classifications , have stimulate us to prefer that the ankle fractures should be managed according to the “stability criterion’s” (4,5,6,13,20,21,22). With them all the signal flaws are eliminated from the other classifications and they have the great advantage that they allow to value in short and long term, the outputs and any therapeutic utilised plan.



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 This is a peer reviewed paper 

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E NIETO-ANDUEZA MD, PhD.Short Oblique Fractures of Distal Fibula
J.Orthopaedics 2004;1(3)e2





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