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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.

Weber B ankle fracture

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.

Smith’s fracture

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.

Oesophageal rupture. Air is seen outlining the right side of the mediastinum

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.