A Novel Algorithm for Isolated Weber B Ankle Fractures: A Retrospective Review of 51 Nonsurgically Treated Patients

• Published in: Journal of the American Academy of Orthopaedic Surgeons Vol. 24; no. 9; p. 645
• Main Authors: Holmes, James R, Acker, 2nd, William B, Murphy, Joshua M, McKinney, Amy, Kadakia, Anish R, Irwin, Todd A
• Format: Journal Article
• Language: English
• Published: United States 01.09.2016
• Subjects: Adult; Algorithms; Ankle Fractures - complications; Ankle Fractures - diagnostic imaging; Ankle Fractures - physiopathology; Ankle Joint - diagnostic imaging; Ankle Joint - physiopathology; Female; Follow-Up Studies; Humans; Joint Instability - diagnostic imaging; Joint Instability - etiology; Male; Prospective Studies; Radiography - methods; Retrospective Studies; Weight-Bearing
• ISSN: 1940-5480
• DOI: 10.5435/JAAOS-D-16-00085

Stability of isolated Weber B ankle fractures can be difficult to determine. Using weight-bearing radiographs, a reliable method to determine the stability of isolated Weber B ankle fractures is described. A retrospective review of prospectively gathered data was performed. Weber B ankle fractures were defined as stable when having a medial clear space (MCS) of <7 mm on initial gravity stress radiographs and a normal mortise relationship on weight-bearing radiographs. Fifty-one patients meeting these criteria were treated nonsurgically with protected weight bearing and serial radiography for 1 year. Average functional score results were: American Orthopaedic Foot and Ankle Society Hindfoot, 93.2; Foot and Ankle Ability Measure for Activities of Daily Living, 93.2; Olerud-Molander Ankle Score, 91.0; and visual analog scale pain score, 0.57. Despite a mean gravity stress MCS of 4.42 mm, no patient demonstrated subsequent MCS widening. Mean MCS on 1-year follow-up weight-bearing radiographs was 2.64 mm. Weight-bearing ankle radiographs are predictive of stability in isolated Weber B ankle fractures. Gravity stress radiographs using traditional measurement criteria may overestimate instability in these injuries. Nonsurgical treatment with protected weight bearing shows good early outcomes. IV.