Abstract
BackgroundDespite the current recommendations that stable Weber B ankle fractures can be treated with functional bracing and weightbearing as tolerated, some reluctance exists among trauma surgeons to follow these recommendations. This paper reports on our institution’s experience in managing these injuries and compare it to the national guidelines. Patients and methodsThis is a retrospective cohort study. Consecutive patients with isolated Weber B fractures referred to the local outpatient clinic over the period of six months were included in the study. Radiographs and clinic letters were examined, the patients were interviewed via telephone to obtain outcome scores [Olerud and Molander score]. Method of immobilisation, weight-bearing status, radiological fracture union, clinical outcomes and complications were all assessed and analysed. ResultsOne hundred and twenty-three patients with isolated Weber B fractures were identified. This cohort of patients did not show clinical or radiographic evidence of instability, they were deemed stable and were initially treated non-operatively. Minimum follow-up period was six months. Sixty-two patients were treated in plaster and were non-weight bearing on the affected limb, while 61 were treated with functional bracing in a boot and were allowed early weight bearing. Three patients showed displacement requiring surgical fixation. All fractures progressed to union and patients were discharged irrespective of the method of immobilisation or weightbearing status during treatment. There was no statistically significant difference in the functional outcome measures between the two groups. The protocol of functional bracing and weightbearing was associated with fewer outpatient clinics and a reduced number of radiographs obtained in the clinic and fewer complications. ConclusionIsolated trans-syndesmotic Weber B ankle fractures, that are clinically and radiologically stable, can be safely treated with functional bracing in a boot and weightbearing as tolerated.
Highlights
Ankle fracture is one of the most common fractures in all age groups, the overall incidence rate in the UK is estimated to range between 7.5 and 12.2 per 10 000. [1, 2] Some studies reported ankle fractures to be the most common fracture in patients between 15–59 years old in United Kingdom (UK) and account for more than 3 million hospital admissions in UK between 2004–2014 [3]
Despite the current recommendations that stable Weber B ankle fractures can be treated with functional bracing and weightbearing as tolerated, some reluctance exists among trauma surgeons to follow these recommendations
Sixty-two patients were treated in plaster and were non-weight bearing on the affected limb, while 61 were treated with functional bracing in a boot and were allowed early weight bearing
Summary
Ankle fracture is one of the most common fractures in all age groups, the overall incidence rate in the UK is estimated to range between 7.5 and 12.2 per 10 000. [1, 2] Some studies reported ankle fractures to be the most common fracture in patients between 15–59 years old in United Kingdom (UK) and account for more than 3 million hospital admissions in UK between 2004–2014 [3]. Ankle fractures has significant financial cost, it is estimated that direct healthcare cost of unstable ankle fracture can be as high as. The stability of the ankle joint following an ankle fracture is a major determinant of the method of managing these fractures. Such fractures include fracture dislocations, bimalleolar and trimalleolar fractures, and high fibula fractures (Weber C) as part of pronation external rotation injuries. [6] Unstable ankle fracture are widely treated surgically, with general belief it yields better outcome, recent studies cast doubts on this belief with no difference in short term outcome between operative and non-operative management of unstable ankle fractures [6,7,8]. We report on our institution’s experience in managing these injuries and compare it to the national guidelines
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