Ankle fractures are common 1,2 and account for 9% of all fractures 3 with an annual incidence of 174-248 cases per 100,000 adults, 4,5 and their prognostication and management are guided by imaging-based classification systems for ankle fractures. 6 The AO Foundation/Orthopaedic Trauma Association's (AO/OTA) revised classification 7 and Weber classification 8 are commonly used to classify ankle malleolar fractures (Fig. 1). The AO/OTA classification is organised around the location and associated characteristics of the fracture. On the other hand, the Weber classification considers the location of the fibular fracture relative to the syndesmosis. 9 Infra-syndesmotic fractures (Weber A) are stable and managed conservatively, while unstable trans-syndesmotic (Weber B) and supra-syndesmotic (Weber C) fractures are managed surgically. 10 Clinical outcomes differ, with good to excellent outcomes reported in 82.7% and 83.8% of Weber A and B fractures, respectively, compared to 70.4% of Weber C fractures. 5 Operative outcomes also vary, with good to excellent results seen in 95.2%, 94.6% and 80.6% of Weber A, B and C fractures, respectively. 11 Various studies have evaluated the inter-observer reliability and intra-observer reproducibility of both classifications, with kappa values ranging from 0.42-0.86 and 0.34-0.93 for AO/OTA and Weber classifications, respectively, 9,12,13 that corresponded with moderate to substantial agreement. 14 In the busy emergency department and clinic session and examination, clinicians and students have only seconds to examine a radiograph before they advise on the likely management-conservative or surgical-of an ankle fracture, and whether 1 or both tibia and fibula require fixation. In the literature, studies that compared Fig. 1. AO Foundation/Orthopaedic Trauma Association (AO/OTA) and Weber ankle fracture classification systems.
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