The lateral malleolus is the distal end of the fibula forming the lateral wall of the ankle mortise and providing the attachment site for the three lateral ankle ligaments (ATFL, CFL, PTFL). Its fracture level relative to the syndesmosis determines the Weber classification (A below, B at, C above the syndesmosis) and directly influences surgical decision-making based on syndesmotic integrity.
Weber classification of lateral malleolus fractures: Type A (below the syndesmosis — syndesmosis intact, treat conservatively in most cases), Type B (at the syndesmosis — syndesmosis may or may not be disrupted, assess with stress views), Type C (above the syndesmosis — syndesmosis disrupted, surgical fixation with syndesmotic repair required). The fibula bears 15 to 20 percent of body weight but its role in ankle mortise stability is critical — widening of the mortise from fibular shortening by even 1 mm increases tibiotalar contact pressure by over 40 percent.
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