Fibular Nail-assisted Reduction and Fixation of Weber C Ankle Fractures Under Direct Visualization

Abstract This technical tip describes a reproducible surgical technique for the treatment of Weber C ankle fractures that combines direct visualization of the syndesmosis with fibular intramedullary nail-assisted reduction and fixation. The approach leverages established methods for confirming syndesmotic reduction through the anterolateral ankle while utilizing the fibular nail not only as a fixation device, but also as a controlled reduction tool to restore fibular length, alignment, and rotation. By minimizing soft tissue disruption and preserving fracture biology, this technique provides a biologically favorable construct with favorable biomechanical properties, particularly in high or minimally displaced Weber C fracture patterns where indirect reduction may be unreliable. This method represents a practical addition to existing strategies for managing complex ankle fractures and may help improve the accuracy and reproducibility of syndesmotic reduction. As this is a technical description of our preferred surgical approach based on clinical experience, no comparative or systematic outcome data are presented. Level of Evidence: Level 5.