Weber Type A Ankle Fracture: Alternative Terminology
A non-displaced Weber type A ankle fracture is also known as a supination-adduction type I (SAD I) fracture according to the Lauge-Hansen classification system.
Classification Systems for Ankle Fractures
Ankle fractures can be classified using different systems, each providing valuable information about the fracture pattern, mechanism of injury, and stability:
Weber Classification
- Type A: Fractures below the level of the ankle joint/syndesmosis
- Type B: Fractures at the level of the syndesmosis
- Type C: Fractures above the level of the syndesmosis
Lauge-Hansen Classification
This system classifies fractures based on the position of the foot at the time of injury and the direction of the deforming force:
- Supination-Adduction (SAD):
- Stage I: Transverse avulsion fracture of the lateral malleolus or lateral ligament rupture
- Stage II: Vertical fracture of the medial malleolus
The Weber Type A fracture corresponds to the Supination-Adduction type I injury in the Lauge-Hansen system 1.
Characteristics of Weber Type A Fractures
Weber Type A fractures have several important features:
- Located below the level of the ankle joint/syndesmosis
- Generally stable injuries
- Usually heal successfully without surgical intervention
- May be transverse in nature
- Often involve the lateral malleolus 2
Management of Non-Displaced Weber A Fractures
Non-displaced Weber A fractures are typically managed conservatively:
- Immobilization: Functional bracing in a removable boot is recommended 1, 3
- Weight-bearing: Early weight-bearing as tolerated is safe and effective 3
- Follow-up: Clinical and radiographic follow-up at 2 weeks and 4-6 weeks to ensure maintained alignment 1
Potential Complications
While Weber A fractures generally have good outcomes, potential complications include:
- Atrophic non-union (rare) - particularly in transverse fracture patterns 2
- Persistent pain
- Delayed healing
Clinical Pearls
- Weber A fractures are considered stable injuries when non-displaced 4
- Functional bracing with early weight-bearing has been shown to be safe, cost-effective, and associated with fewer outpatient visits and complications compared to non-weight-bearing casts 3
- Stability is the most important factor when deciding between operative and non-operative management 4
- Careful assessment for concomitant injuries is important, as isolated medial malleolar fractures are rare and may indicate additional injuries 5
When to Consider Surgical Management
Surgery should be considered in the following scenarios:
- Displaced fractures with >2mm displacement
- Evidence of ankle joint instability
- Development of symptomatic non-union after conservative management 2
Remember that while these fractures typically heal well with conservative management, patients should be counseled about the rare possibility of symptomatic non-union 2.