A Fulcrum-Assisted Reduction Technique Using a Novel "Seesaw" Plate Mechanism for Enhanced Stability in Unstable Weber B Ankle Fractures

The management of unstable Weber B ankle fractures presents significant challenges, particularly in patients with osteoporotic bone. Conventional fixation techniques often employ a lag screw to achieve compression at the fracture site. However, in osteoporotic bone, this approach may fail to provide adequate compression and may cause complications such as irritation to surrounding tendons or the distal tibiofibular syndesmosis, sometimes necessitating additional surgery for hardware removal. We describe a novel "seesaw" technique that uses a laterally applied, obliquely oriented locking plate to achieve stable fixation. After initial provisional stabilization with a K wire instead of a lag screw, the distal end of the plate is secured with locking screws. A non-locking screw is then inserted just proximal to the fracture site, serving as a fulcrum. By applying posterior pressure to the plate, a "seesaw" motion is induced, translating the distal fibular fragment anteriorly. This maneuver enables compression across the fracture site and restores anatomic alignment. Final fixation is completed with additional locking screws. Over a three-year period, this technique was employed in more than 50 patients with unstable Weber B fractures. No cases of syndesmotic instability, malalignment, or loss of reduction were observed during the rehabilitation period. This method provides a stable, reproducible alternative to standard fixation techniques and is especially advantageous in osteoporotic bone. It allows for precise anatomic reduction, sustained fracture compression, and early mobilization, potentially reducing complication rates and the need for secondary procedures.