Weber B ankle fracture

This is a trans-syndesmotic fracture with usually partial - and less commonly, total - rupture of the syndesmosis. According to Lauge-Hansen, it is the result of an exorotation force on the supinated foot.

The fracture starts anteriorly at the level of the ankle joint and extends in a posterior and proximal direction.

• Stage 1 - Rupture of the anterior syndesmosis.
• Stage 2 - Oblique fracture of the fibula (this is the true Weber B fracture).
• Stage 3 - Rupture of the posterior syndesmosis  or - fracture of the malleolus tertius.
• Stage 4 - Avulsion of the medial malleolus or - rupture of the medial collateral bands.

Smith’s fracture

● Fall onto the dorsum of the hand or due to a direct blow.
● Patient presents with a swollen tender wrist with associated deformity.
● Often described as a reverse Colles’ fracture.
● AP and lateral views recommended as may appear similar to Colles’ fracture if an AP view alone is examined.
● Transverse fracture through the distal radial metaphysis with associated
volar angulation and volar shift.
● Look for median nerve symptoms.

Oesophageal perforation/rupture

● Classically described following a forceful vomiting (Boerhaave syndrome).
● Commoner causes include – iatrogenic trauma, blunt/penetrating trauma, chemical injury, foreign body perforation, spontaneous rupture and postoperative breakdown.
● The oesophagus has no serosal covering and hence perforation allows direct access to the mediastinum.
● Perforation of the upper/cervical oesophagus allows access to the retropharygeal space.
● Perforation of the lower/mid-oesophagus tends to directly enter the mediastinum. Inflammatory reaction causes contamination of the pleural space.This is facilitated by negative pleural pressure.

● CXR: Classic signs are subcutaneous emphysema, pneumomediastinum, left sided pleural effusion, hydropneumothorax and mediastinal widening.
● Cervical spine: Lateral views may reveal retropharyngeal air.
● Pleural effusions, pulmonary infiltrates and a true mediastinal air–fluid level are not typically seen with a spontaneous pneumomediastinum.
● Water soluble contrast studies are of benefit to demonstrate perforations. If no perforation is seen a barium swallow will show better mucosal detail.These studies can be repeated over time.