Have you ever rolled your ankle during a run, landed awkwardly after a jump, or misjudged a step? Have you heard of someone who fell from a height or was in a car accident and sustained injuries? These moments might seem minor at first, but they can sometimes lead to a serious ankle injury called a Weber fracture.

Ankle fractures account for up to 10.2% of all ankle fractures, which are recognised as the second most common fracture necessitating hospitalisation. A Weber fracture type affects the fibula, a thinner bone running along the outside of your lower leg, and the surrounding ligaments. The Danis-Weber classification system categorises fibula fractures at the ankle based on the fibular fracture’s relationship to the tibiofibular syndesmosis. This classification is pivotal in guiding treatment decisions and assessing fracture stability.

The highest incidence in males is generally observed between 15 and 24 years of age, whereas in females, the peak incidence occurs later in life, between 75 and 84 years. Younger males are more prone to high-energy trauma due to their engagement in high-risk activities, while older females are more susceptible to low-energy falls, often linked to age-related bone density loss.

If left untreated or managed improperly, it can result in long-term instability, chronic pain, and reduced mobility But don’t worry. Understanding this injury is the first step to getting better. Let’s take a closer look at what a Weber fracture is and why it’s so important to treat it correctly!

Weber fractures happen when your ankle rolls outwards, the forces transmitted through your ankle slide and twist the bones off their normal track, the ligaments provide backup, take up the slack, and the muscles try to help by bracing. This outward twisting force travels up the fibula and tibia, causing stress along its length like a stick squeezed. However, the structures on the side of your ankle are not designed to handle immense sideways forces, combined with your weight pressing down on them, not to mention rotational forces. The muscles tear, ligaments rupture, and the bone buckles, cracks, splinters, and breaks apart, piercing the surrounding tissue. The damage is classified by the extent to which the crucial ligament keeping your Tibia and fibula together is intact, the Syndesmosis.

The broken bone can extend downwards in a sideways or spiral pattern. However, the main concern is the stability that your syndesmosis can provide to keep your Tibia and Fibula together, preventing them from splitting apart. This gives us a clear marker to determine the best course of treatment.

• Weber A: The fibula fractures below the syndesmosis. These are more stable and often amenable without surgery. The tibiofibular syndesmosis and deltoid ligament are intact and able to transmit force.
• Weber B: The fibula fractures at the level of the syndesmosis, frequently extending downwards in a sideways or spiral pattern. This involves partial damage to the syndesmosis, giving rise to its questionable stability.
• Weber C: The fibula fractures above the syndesmosis, accompanied by more severe ligament disruption and guaranteed ankle joint instability. The separation of the Tibia from the fibula detaches the bone, allowing the Talus to push higher up into the shin. Even if you don’t understand what I’ve said, it doesn’t sound normal, and these Weber fractures must be surgically corrected.

What happens on a cellular level?

Apart from the obvious bone fractures, the destruction disrupts multiple ligaments, tears muscles, ruptures blood vessels, and stretches the joint capsule, which plays a crucial part in motion. So, if you’re aiming only to seal up the bone, you’ve got a long way to go. A solid pole is also stable, but needs the well-oiled nuts & bolts to allow smooth motion.

Bone breaks under pressure, especially when combined with rotational twisting. When muscles, ligaments, and tendons fail to guard against a defenceless motion, the bone buckles, cracks, splinters, and shatters. The bone acts as the foundation for ligaments and muscles to anchor; thus, if the pillars collapse, the whole structure implodes. Blood vessels inside the bone leak bone marrow into the surrounding area.

While ligaments, tendons, and muscles are stretched beyond their limits, they rupture, snap, and tear off the anchor on the bone. In Weber Type A fractures, the ligaments hold on despite the casualties and stay intact. This usually doesn’t spare the Blood vessels carrying vital nutrients. Blood leaks into the ankle fracture site, causing swelling. Swelling plays a dual role – stabilising your ankle in the absence of ligaments and plays a role in your body’s default repair mechanism. However, extreme swelling can compromise blood flow to your foot and slow your recovery.

A small joint with big responsibilities. Despite its compact size, it is a powerhouse of strength, stability, and flexibility. The ankle bones provide the framework, and the ligaments keep these bones aligned, stable and in position while your full body weight transfers through them. Thus, disruption of this system transmits ripple effects, disturbing the smooth and controlled movement in your ankle.   

Bones of the ankle

The ankle joint, also known as the talocrural joint, is formed by three key bones that create the framework for stability and motion:

• Tibia (Shinbone): The largest bone in the lower leg, bearing most of your weight. It forms the inner part of the ankle joint and is called the medial malleolus.
• Fibula: A thinner bone on the outer side that contributes to ankle balance and stability. The bottom part makes up the lateral malleolus.
• Talus: This small bone is positioned at the base of the ankle above the heel bone. It connects the tibia and fibula to the foot, allowing for efficient force transfer during movement. It is also responsible for most movements within your ankle joint.

Ligaments of the ankle

Ligaments are rugged, fibrous tissue bands that connect bones and provide joint stability. Several key ligaments protect the ankle joint.

• Medial (Deltoid) Ligament: Located on the inner side of the ankle. It looks like a fan-shaped ligament that prevents the ankle from rolling inward.
• Lateral Ligaments: Found on the outer side of the ankle and include:
  • Anterior Talofibular Ligament (ATFL): Resists your foot sliding forward on the lower leg.
  • Posterior Talofibular Ligament (PTFL): Resists your foot sliding backwards on your lower leg.
  • Calcaneofibular Ligament (CFL): Provides stability outside your ankle joint.
• Syndesmosis: This keeps your tibia and fibula together, ensuring they remain tightly aligned. It is critical for weight-bearing and maintaining stability during movement.

Muscles and tendons around the ankle

Muscles and tendons surrounding your ankle are the motors and cables that produce movement and shock absorption for your ankle:

• Calf muscles (Gastrocnemius and Soleus): These muscles attach to the heel via the Achilles tendon and point your toes downward.
• Peroneal muscles (Fibularis Longus and Brevis): Located on the outer side of the lower leg. It helps stabilise your ankle while pointing your toes and tilting your foot outwards.
• Anterior Tibialis muscle controls lifting your foot upwards and decelerating a landing while also providing balance.

Nerve supply

The nerves of your ankle are responsible for relaying messages of feeling and recruiting muscles to contract. Key nerves include the Tibial Nerve, which controls the muscles in the back of the leg and provides sensation to the heel and sole of the foot. The Deep Peroneal Nerve provides sensation to the space between the big toe and second toe and controls pointing your toes upwards. The Superficial Peroneal Nerve supplies your ankle’s outer side and the top of your foot.

The ankle is not a simple hinge, but rather a dynamic, multi-purpose joint.

Supports your body weight: The ankle supports your entire body weight whenever you stand, walk, or run. For this reason, it acts like the very foundation of a building: it keeps you upright and balanced.

Helps you move: Your ankle lets your foot move various ways, such as:

• Plantar flexion: This is the movement that points your toes downward, as in the action of a pedal in an automobile or a push-off when running.
• Dorsiflexion: Pulling your toes up, as if walking uphill or climbing stairs.
• Inversion and eversion: Refers to the rolling of your foot inward or outward, enabling you to walk on uneven surfaces.

Absorbs shock: Each step you make requires your ankle to absorb the shock that might occur, thus helping your body not to stress any more. It plays an important role during high-impact activities like running and jumping.

Keeps you balanced: The ankle keeps readjusting to maintain your body upright, whether you’re staying still or walking. Ligaments and muscles around the ankle work together, holding you from wobbling or falling.

Accommodates various surfaces: The ankle can be flexible to take on uneven ground, slopes, and other tricky surfaces; it adjusts the position of your foot so that you may keep your balance.

Transfers energy for locomotion: The ankle acts like a spring, transferring energy from your leg muscles to your foot, hence making your movements smooth and efficient. For example, when you sprint, your ankle transfers power from your calf muscles to your foot, helping you push off the ground and move forward quickly.

There are two distinct categories of patients, the first is the hardworking, adventurous adrenaline junky young Adult (especially males) that get a Weber fracture during high-energy trauma, such as sports injuries, motor vehicle accidents, and occupational hazards. Common amongst ages 10 to 19 and is usually caused by a freak accident, unforeseen and unavoidable. The mechanism of injury is not merely a causative factor but also a strong predictor of the fracture pattern.

The second category is the unconditioned elderly female with an unsuspecting, lurking low bone density who merely ‘sprained’ her ankle. This category is Low-energy trauma, mainly a simple fall from standing height, which accounts for most injuries. Even seemingly low-energy falls can lead to complex and unstable fractures due to underlying bone fragility. Multiple factors underpin bone health, and you must consider checking the following.

• Osteoporosis: Hormones like estrogen are key in producing bone maintenance cells. 
• Nutritional deficiencies: Inadequate intake of calcium, vitamin D, and other essential nutrients. A lack of them absorbs nutrients from the available stores, your bones.
• Arthritis: Conditions such as rheumatoid or osteoarthritis can erode joint stability and bone strength, increasing the risk of a Webser fracture.
• Peripheral neuropathy: Reduced sensation in the feet and ankles increases the likelihood of missteps and the risk of falling.
• Chronic ligament laxity: Genetic or acquired conditions that loosen ligaments reduce ankle stability.
• Advanced age: Older individuals often experience decreased bone density and slower reflexes, increasing their risk of falling.
• Sedentary lifestyle: Weak muscles, poor conditioning and poor balance lead to instability.
• Twisting or rotational movements: Sudden or forceful ankle twisting, as seen in sports like soccer or tennis, places excessive stress on the fibula and ligaments.
• Uneven surfaces: Walking or running on rocky or slippery trails heightens the chance of rolling the ankle into unfamiliar territory.
• Landing with poor alignment: Landing with an uneven or misaligned foot during jumping or stepping down creates excessive angular forces on the ankle
• High-impact activities: The higher the risk, coupled with the unfamiliar motion, is a recipe for disaster.
• Improper footwear: Protective shoes can mitigate and limit potential catastrophe and minimise the likelihood of your ankle rolling outwards.

Depending on the severity of the injury, a Weber fracture can present with a range of symptoms. It can make everyday activities challenging. Recognising and understanding the signs of a Weber fracture is essential for early diagnosis and proper treatment, ensuring the injury doesn’t lead to long-term complications, compensation, and persistent pain.

If you suspect a Weber fracture, a few simple self-tests can help you identify the warning signs. While these tests won’t replace a professional diagnosis, they can give you a better understanding of the severity of your injury. Paying attention to pain, swelling, and movement limitations.

A Weber Type B and C fracture has obvious, visible disfigured and magged bone fragments that require a visit to your local Emergency Room’s casualty department, where they’ll prioritise, X-ray and determine the extent of the damage. The Undetected Stable Type A and B fractures may be less evident. All fractures require some form of medical intervention, and to give you a better perspective of the scope of the problem, here are key markers our medical professionals use to gauge the severity.

Firstly, the location in proximity to the syndesmosis clearly classifies the stability of the fracture site. Here’s where Weber’s classification comes quite handy. If syndesmosis is involved, its stability is compromised to some degree; the area and size of the ankle fracture will guide us in deducing the potential structural integrity of the bone.

The amount of movement and load-bearing capacity are strong predictors of severity. This directly impacts how much you can do. The lower the load required to send you shooting through the roof, the more severe the ankle fracture, especially in Type B and C Weber fractures. Even if you can still move your ankle, it doesn’t mean it’s not cracked. When muscles contract, they compress bone over a fracture site, so jumping might be out of the question even if you’re still able to move.

Your ankle range of movement and its limitations slide and glide the connecting surfaces of the Tibia, Talus and fibula, which join together to establish if they’re still moving within certain boundaries and don’t slide off their track or allow the Talus to slip up, separating the Tibia and Fibula. Simply pointing and flexing your foot upwards about 20 degrees and 50 degrees downwards, with a combined normal arch of motion of about 70 degrees. The less you’re able to move your ankle, the more severe the tissue damage.

Swelling can vary from slight puffiness to “it’s oozing”, usually combined with discolouration of bruising around the whole ankle. It’s a good sign when the swelling is one-sided and dominant, considering the vasculature on the opposite side remains intact. Visible blue under the skin is a clear sign that the arteries supplying nutrients and oxygen to your foot are compromised, combined with venous blood and plasma spilling into the injury site. Bone marrow and splinters of the spongy bone matrix inside the bone can seep out, acting like splinters in a water balloon, getting trapped as you move.

Splinters and bone fragments produce a very particular grinding sound. They are usually not too painful because bones don’t have a lot of pressure and pain receptors. However, the outward expansion of your ankle due to swelling causes most of the pain.

A numb, dead or floppy foot is considered a medical emergency, as the fractured pieces may have severed the nerves running down your foot, ceasing all transmission of pain and movement. It’s more common to feel numb patches over the bottom of your foot and the front and inside of your ankle. Here, smaller nerve branches are severed and tugged. We consider a fracture regressing when nerve symptoms develop, such as Pins & Needles, dead feeling, numbness or burning, which explains why we monitor the fracture closely in the initial phase. These nerve symptoms are a slow, gradual increase in the pressure on the nerves from the surrounding tissue damage, leaking plasma, pooling blood, thigh socks or braces. These nerves control the pump action of the blood through the arteries, and when they get cut off, the situation deteriorates.

Risks of Prolonged Immobilization

• Blood clots: Reduced blood flow in the leg increases the risk of deep vein thrombosis (blood clots), with symptoms including swelling, warmth, redness, or pain in the calf. In severe cases, a clot can travel to the lungs, causing a pulmonary embolism, which may present as sudden shortness of breath, chest pain, or rapid heartbeat. These complications are life-threatening and require immediate medical attention.
• Lung infections: Extended periods of immobilization can increase the risk of lung infections, particularly pneumonia. Limited movement reduces the ability to fully expand the lungs, leading to decreased airflow and the buildup of mucus, which creates an environment for bacteria or viruses to thrive. This risk is further compounded in individuals who may already have compromised respiratory function or spend prolonged periods lying down.

Timely diagnosis, appropriate treatment, and adherence to a comprehensive rehabilitation plan are critical for achieving a successful recovery and minimizing risks.

Our physiotherapists are experts in testing and diagnosing the structures in and around your ankle. We’ll give you peace of mind and explain the extent of the fracture, especially Weber fractures, and more importantly, we’ll explain the treatment goals you must achieve to make a full recovery. With years of experience in diagnosing and managing ankle injuries, our assessment and screening will guide our next step in deciding the best course of action. If we suspect you have a Weber fracture, we will refer you for an X-ray to confirm the fracture’s location, size, and alignment, and establish whether or not it’s stable to continue non-surgical treatment.

For Weber A and B fractures, non-surgical management is a suitable alternative to operative treatment, especially for non-displaced injuries. The integrity of the deltoid ligament, a crucial ankle stabiliser, plays a significant role in predicting the success of conservative management for Weber B fractures. Research supports non-surgical management as the standard approach for stable isolated lateral malleolar fractures, which encompass stable Weber B types.

If a Weber fracture does not cause your ankle pain, we will assess other potential causes by testing structures such as joints, ligaments, muscles, tendons and nerves. We carefully analyse how these structures interact and stress them to pinpoint the root cause of your problem. Our knowledge and expertise guide our clinical reasoning to make sense of your pain, with a personalised approach and the right plan to give you the best chance to be your best.

X-rays are the most effective method for diagnosing a Weber fracture of the ankle. They help us determine the fracture’s location, size, depth, and alignment, which is essential for accurate Weber classification. If needed, your physiotherapist can refer you for X-rays to be taken.

Ultrasound is a valuable tool for diagnosing soft tissue injuries linked with Weber fractures. It provides real-time, high-resolution imaging of ligaments, tendons, and muscles, allowing for the detection of partial or complete tears, bone browsing, anchor integrity, inflammation, and hematomas.

If you need an ultrasound, your physio will refer you.

An MRI scan provides detailed images of all structures in the ankle, including bones, ligaments, nerves, and soft tissues. However, an MRI is usually unnecessary and costly for a straightforward ankle fracture. It is typically reserved for complex fractures involving multiple bones and displaced bone fragments, like Weber Type C fractures or borderline surgical Type B Weber fractures. In these cases, the scan helps the surgeon determine the best approach to realign and stabilise the broken pieces.

If your physiotherapist suspects a complex fracture, they will refer you to a specialist authorised to order an MRI scan for further evaluation.

Taking a “wait and see” approach to a Weber fracture can often result in worsening pain, guaranteed compensation, and subtle joint instability. It’s safer to allow a medical professional to monitor your bone healing and progress during recovery, as problems may arise weeks or years after the initial injury. When a Weber ankle fracture is left undiagnosed, untreated and unmonitored, there are a few scenarios that can play out:

Not attached: Non-union occurs when the broken ends of the fibula do not reunite adequately. Without properly stabilising the fractured segments, the bone pieces may drift and shift further apart. 

Unrestricted motion too fast over the ankle fracture site experiences prompressive, rotational forces too early, then bone bridging is forming, or the callus is just getting set, specific movements will break off and shear through the repairing bone, disrupting the fusion of the bone fragments, and considerably slowing healing. A subtle instability creeps in. This anatomical imperfection, even if seemingly minor, drastically reduces joint contact area, leading to concentrated stress on the articular cartilage. This increased stress then directly contributes to cartilage damage, which evolves into the development of post-traumatic arthritis. The long latency period for post-traumatic osteoarthritis, which only manifests years after the initial injury, means that initial “successful” fracture healing might mask underlying biomechanical abnormalities that will lead to severe arthritis much later.

Malunion is when the bone attaches, but entirely in the wrong anatomical place, linking the Tibia, Talus and Fibula awkwardly together, like a 3-year-old, a bottle of glue, and broken ceramic – it’s not going to be ‘the best’. In about 8% of patients, the bone mistakenly reattaches on a different site, the muscles, tendons and joints are entirely out of sync, and the mechanics are severely disrupted due to inadequate force generation, decelerations, absorption, elasticity, and extensibility that assist in redistributing forces away from the bone. Even a seemingly minor 1mm lateral shift of the talus within the ankle mortise can lead to a drastic 42% decrease in the tibiotalar contact area, significantly increasing uneven contact stresses across the joint. This altered biomechanics is a direct precursor to accelerated cartilage damage and instead concentrates force, stressing the bone and surrounding tissue even more.

Aesthetics: As the Weber fracture heals, it generates new bone tissue, creating a callus, a soft and flexible blob that is moldable and easily deformed. The improper bone alignment or bulges can stick out, creating a visible deformed bone, or even worse, when it moves into the space where movement structures operate, creating interference with muscle, tendons, capsule, ligaments. Frequent pain with movement is a key sign here.

Stiffness: When fractures are not adequately immobilised or supported, the affected site experiences micro-movements that grind away repair matrix, deforming callus, creating friction over joint spaces, restricting movement, and impeding the healing process. The synovial membrane that lubricates the joint’s moving parts rusts up. This deconditioning is a direct consequence of the brace or POP. The constant dull ache with pain spikes as you move to the end of your available range usually creates intermittent, fluctuating pain.

Weakness: Muscles erode and disappear to the point where the ankle, foot, and even the calf look delicate and frail, unable to hold your weight.  Keeping the muscles active without compromising the fracture site will prevent a lot of effort that’s spent building the muscle back up. Your body uses muscles, especially your calves, to help pump blood more effectively, helping with the circulation of vital oxygen and nutrients to reach your toes. Without this pump, the blood pools in the legs, adding pressure to pain-sensitive structures. Swelling has a direct relationship with pain.

When a Weber fracture goes untreated, you may find yourself trapped in a vicious cycle of pain and uncertainty. Pain makes you hesitant to move the ankle, leading to joint stiffness and muscle atrophy. The less you move, the more stiffness, and the muscles waste away with ‘rest’. This leaves your ankle feeling weak and unreliable, increasing your risk of complications, overloading your good side and making you an even greater fall risk.

Addressing a Weber fracture promptly through appropriate medical intervention helps prevent, limit and avoid these complications to ensure a smoother recovery process.

Late Displacement

A critical consideration in the non-surgical management of ankle fractures, particularly for Weber B types, is the dynamic nature of fracture stability. While an initial assessment may deem a fracture “stable,” there remains a recognised risk of late displacement or subtle instability that might develop after the first assessment. This potential for secondary displacement can necessitate a conversion to delayed surgical intervention, prolonging the overall recovery period and potentially increasing complexity. This highlights that the diagnosis of “stability” is not always a static determination but requires ongoing vigilance and robust follow-up. The potential for a fracture to become unstable over time underscores the importance of monitoring by our practitioners to ensure the continued suitability and continued non-surgical treatment. Research reports there’s about a 10.6% risk of this occurring within the first two weeks.

The consequences of leaving a Weber fracture untreated increase the chances of developing secondary complications. Apart from the normal stiffness, weakness, and compensation, these not only slow recovery but also risk even more widespread tissue damage due to fragment displacement, infection, blood clots that form inside the veins, or the occlusion of the arterial blood supply, halting oxygen and nutrient transport to the ankle.

Not following immobilisation guidelines: A frequent mistake is failing to keep the ankle immobilised in a cast, splint, or brace for the recommended timeframe, especially when late-night hobbling to the toilet. Removing the support prematurely causes micro-translations that disrupt the bone bridging the gap, shifting the fragments either to attach in the wrong position or drift apart or not to attach at all.

Underestimating the importance of rest: Some patients try to “push through the pain” or assume that minimal rest is sufficient, returning to activities too early. Overloading the injured ankle delays healing and increases the risk of prolonged recovery or non-union. Proper rest during the inflammatory phase is essential for stabilizing the bone and surrounding tissues.

Delaying rehabilitation: Postponing physiotherapy due to fear of pain or assuming it’s unnecessary can lead to muscle weakness, joint stiffness, and reduced range of motion. Waiting too long to begin rehabilitation makes regaining normal function more challenging.

The risks of “Wait and See”

Ignoring pain or delaying treatment not only slows recovery but can also cause irreversible damage. Poor healing mechanics can result in ongoing pain that becomes a part of daily life. Misalignment or cartilage damage increases the risk of developing post-traumatic arthritis. Prolonged healing or malunion can cause stiffness and loss of range of motion, affecting your ability to walk, run, or perform everyday tasks. An unstable ankle is more prone to giving out, leading to additional fractures or soft tissue damage.

Untreated Weber fractures can have significant long-term consequences. Seeking medical care early can help prevent these complications and promote proper healing.

Misusing pain medication:

• Patients may misuse pain medication by either over-relying on it or stopping it prematurely.
• Overuse: Painkillers can mask symptoms, causing patients to overuse the injured ankle and worsen the fracture.
• Underuse: Avoiding necessary medication can make rehabilitation unbearable, leading to skipped exercises. Pain management should aid recovery, not replace it.

Unrealistic Recovery Expectations: Expecting a quick recovery or assuming the ankle will heal without effort often leads to frustration and poor adherence to treatment. Recovery takes time, and rushing can result in chronic instability or arthritis.

Ignoring Swelling or Secondary Symptoms: Swelling, stiffness, or tingling sensations are often dismissed as normal but could indicate poor circulation, nerve involvement, or improper healing. Ignoring these signs can lead to chronic pain or reduced ankle function.

We are committed to providing exceptional care for your broken ankle and guiding you toward recovery. We know that Weber fractures can bring uncertainty, especially when returning to life, especially in sports. That’s why we’re here to offer reassurance, guidance, and a clear path forward to help you overcome these challenges. Our role is to assess the stability of your ankle fracture, whether Type A, B or C  and monitor the dynamic nature of this ‘stability’. Our ongoing assessment highlights that the success of non-surgical treatment is not solely about achieving bone union, but critically about achieving anatomical union to preserve long-term joint integrity.

Our rigorous monitoring of fracture alignment throughout the healing process is critical. Using our in-depth knowledge of ankle fracture treatments, we’ll design a recovery plan customised to your specific needs. This plan will focus on addressing every aspect of your Weber ankle fracture, including alleviating pain, building strength, and monitoring the stability of your ankle joint. Our goal is to help you regain confidence in your movement and return to the activities you enjoy most, while pushing at full throttle.

Following your treatment plan from start to finish is key to achieving a full recovery. Our primary objectives of non-surgical treatment are to maintain the fracture’s anatomical alignment and provide sufficient stability to facilitate proper bone healing, with constant monitoring and reassessment of ankle internal stability, and treatment for even subtle malalignment. It is crucial to prevent any secondary displacement, non-union, malunion, stiffness, osteoarthritis, and the progression to debilitating long-term complications.  We’ll help you rebuild your strength and get back to hopping, skipping, and jumping without hesitation. Trust us to guide you every step of the way!

Your recovery time is directly linked to the type of Weber ankle fracture you have.

Healing times depend on the stability of the fracture, whether bone union takes place and most importantly, if anatomical union can be maintained during load-bearing activities. Type A and B Fractures start off with a 6 – 8 Week active rest phase until the bone is reunited/ but mendable. It’s followed by another 8 weeks of a gradual load progression phase where the bone is re-modelled and shaped by placing particular stress on the bone in different positions and taking the ankle into certain motions. The Bone Maturity phase of Weber fractures takes about 4 months, prioritising high load, impact tolerance and power generation, which is assessed and tested in a safe environment. Here, the focus shifts to eliminating compensatory movement patterns that may, over the long run, put undue strain on the unaffected side.

Current research documents incomplete functional recovery even 24 months after the initial fracture, especially stiffness. However, our track record has proven that we can achieve a return to work in 4 months and a return to full-impact sports in 12 months.

Managing Weber fractures involves a comprehensive, multidisciplinary approach that includes general practitioners, pain management strategies, rehabilitation devices, and specialised therapies.

General practitioners: They play a role in prescribing pain relievers or anti-inflammatory medications to help manage pain and inflammation throughout the rehabilitation process. They also help with the management of any external medical conditions that may influence your healing or general health.

Corticosteroid injections: Pain management may also involve corticosteroid injections in cases of severe inflammation, although these are more commonly used for soft tissue issues rather than fractures.

Immobilization devices: Devices such as casts, moonboots, or braces, provide early stability and protection but must be gradually discontinued to prevent muscle atrophy.

Biokinetics: In the later stages of recovery, biokinetics becomes essential, focusing on functional movement training and sport-specific conditioning to rebuild strength and reduce the risk of re-injury.

Other treatments: Advanced treatments like platelet-rich plasma (PRP) injections, can support soft tissue repair, while vitamin supplementation including calcium and vitamin D can promotes bone healing and tissue regeneration.

Weber Type A is generally Stable ankle fractures defined by a solitary fibular break that preserves the overall integrity and stability of the ankle joint, and is usually managed without surgery with a high success rate.

Several factors must be evaluated before deciding on surgery. The stability of the fracture fragments, syndesmosis involvement, integrity of the deltoid ligament, and risk of displacement are the key deciding factors in whether a Weber Type B fracture necessitates surgery. Other secondary markers include the extent of the damage to the surrounding muscles, tendons, and ligaments that provide dynamic stability. All of these factors combined determine the overall stability of your ankle joint and will be considered before deciding to operate.

Unstable Type B or C ankle fractures are associated with a significantly higher non-union rate, ranging from 48% to 73%, reinforcing the critical importance of accurate stability assessment for non-surgical treatment. Typically, Weber C ankle fractures are mostly stabilised in the theatre.

Surgery is necessary when non-surgical treatment fails. This is when the fibula bone fails to heal; this is when there are no radiological signs of healing for a minimum of nine months and no progression for three consecutive months. Success after surgery depends largely on the rehabilitation phase, which focuses on reintegrating the ankle into daily activities, rebuilding strength, and adapting to the structural changes made during surgery.

Ankle Sprain
An injury to a ligament caused by overstretching or tearing from an ankle twist. X-rays show normal bone structures, but tenderness is usually localised over the gap between the outside knob of your ankle and your heel. Here, the ligaments tear without a fibula fracture.

Stress Fracture of the Fibula

A hairline crack in the fibula caused by repetitive stress or overuse, commonly seen in runners and athletes. Stress fractures develop gradually, with pain that worsens over time and after activity.

Talar Dome Lesion (Osteochondral Injury)

Damage to the cartilage and underlying bone of the talus, often caused by trauma or ankle sprains. Talar dome lesions cause deep ankle pain felt inside the joint and may be accompanied by catching or locking sensations, which are not common with Weber fractures.

Peroneal Tendonitis

Peroneal tendon injuries are injuries to the tendons running along the outer ankle, often caused by overuse or triggered by trauma. It leads to pain and swelling along the back and outside of your ankle, usually exacerbated with movement.

Chronic Ankle Instability

A condition where the ankle repeatedly gives way, often due to multiple ligament sprains and inadequate rehabilitation. Patients report a history of frequent ankle injuries and instability without a single significant trauma or fracture.

• Lateral malleolar fracture
• Fibular fracture
• Ankle fracture
• Perimalleolar fracture
• Fibular displacement fracture
• Broken ankle
• Bimalleolar fracture of the ankle
• Trimalleolar ankle fracture
• Avulsion fracture of the ankle
• Maisonneuve ankle fracture