Do stable Weber B ankle fractures pose an unnecessary load on fracture clinics? A prospective review of 100 patients

A. Konarski, S. Ahmed Kamel, A. Pillai

Introduction: The conservative management of stable Weber B fibula fractures remains variable. We thought that the current trend in our institution poses an unnecessary burden on fracture clinics.

Methods: We reviewed patients referred with Weber B ankle fractures over an 18 month period. Our inclusion criteria were non-diabetic adults, with isolated stable Weber B fractures. Fractures were deemed stable if they had no evidence of talar shift on initial radiographs (< 5mm medial clear space and < 1mm variation between superior and medial clear spaces). Exclusion criteria were unstable fractures on radiographs, or no local follow-up. Management was reviewed from case notes and radiographs. Primary outcome was the stability of the fracture by the end of treatment. Secondary measures were duration of treatment, number of follow up appointments and radiographs, and complications.

Results: 182 cases were reviewed. 82 were excluded leaving 100 patients for follow-up. Mean age was 53 (18-99). Mean number of outpatient appointments was 2.63 (1-6), follow up radiographs was 2.34 (0-6). 74 were treated in a walking boot and 15 in a walking cast for a mean of 6 weeks (4-9) and allowed to full weight-bear. 10 were kept non weight-bearing in a cast for 6 weeks and 1 was partially weight-bearing. Mean follow-up time was 7.3 weeks (1-30). No fractures displaced and one patient developed an ulcer from a cast.

Conclusion: Our study suggests that in isolated Weber B fractures, with no radiographic instability on initial presentation, further displacement is unlikely. We propose that these injuries can be treated safely in a removable boot with full weight-bearing for 6 weeks then clinical and radiologic assessment if required. Casting or restricted weight-bearing does not confer any additional advantage.
We question the necessity and rationale behind weekly clinical and radiological follow-up for such cases.