Could Weber type A fractures result in long term ankle problems?

G. Williams, J. Ballester, D. Withers, D. Bailey

Introduction: The literature contains few studies providing more than 5 year follow up respect to ankle fractures. Our aim was to objectively score long term outcome in respect to fracture injury patterns at our institution.

Methods: Our trauma database identified 152 adult ankle fracture patients from 2004-2007 (5-8years follow up) treated with ORIF or conservative management appropriately according to standard fixation techniques for simple fracture patterns. 70 patients were unavailable at time of follow up due to incorrect contact details, death or inability to participate due to confusion or medical illness leaving 82 patients (42 male, 40 female) mean age 52 years (range, 19 to 92) for analysis. Each patient completed the foot and ankle disability index (FADI) score (0-100). Radiographs were analysed for fracture pattern.

Results: Overall mean FADI score was 90 (range, 15 to 100). 3 fracture patterns were associated with above average functional scoring (p< 0.01): uni malleolar fractures of the medial side (n = 6, FADI: 99), isolated Weber B (n = 30, FADI: 93) and Weber C (n = 3, FADI: 100) injuries. Fracture patterns with below average outcomes were: tri-malleolar (n = 12, FADI: 87), bi-malleolar (n = 17, FADI: 86), isolated Weber A (n = 11, FADI: 85) and miscellaneous injuries including isolated posterior malleolus or syndesmotic injuries (n = 3, FADI: 88). These injury patters were significantly associated with worse functional outcome at 5-8 year follow up (p< 0.01, unpaired students t test).

Conclusions: Although Weber A injury patterns are traditionally considered benign our study suggests below average functional recovery for a large proportion of these injuries, this may be due to unreported fiberous / non union, instability or peroneal symptoms for this patient group. We aim to undertake further investigation into possible causes for these findings.