Weber B ankle fracture: an unnecessary fracture clinic burden
Section snippets
Background
There is no doubt that trans-syndesmotic, Weber B type fractures can be unstable fractures. Medial deltoid ligament competence is important for there to be a stable fracture configuration. Such signs as medial tenderness or bruising and radiological evidence of pathological talar shift or tilt can be useful in deciding whether the deltoid ligament is ruptured. If there is no injury to the deltoid ligament then it is said to be a stable injury1., 2. (see Fig. 1). The implications are that the
Patients and methods
We studied 53 consecutive Weber B ankle fractures through our trauma clinics over an 18-month period. The initial treatment for all fractures was non operative management in a below knee cast. All patients notes and radiographs were collected and scrutinised. Diagnosis of Weber B fracture was confirmed and any talar shift was noted on the initial antero-posterior and lateral radiographs. Subsequent X-rays taken over the first weeks of treatment were studied. Further talar displacement, if any,
Results
All of the 53 Weber B fractures showed a congruent mortice on initial AP radiograph. None of these showed any measurable increase in medial talotibial gap when compared to the subsequent AP ankle radiographs taken. The median age was 40 years (range 20–86). The median time between A&E presentation and trauma clinic review was one day (range 1–6). Each patient had an average of three sets of AP and lateral radiographs with the last taken at a median of 21 days post fracture. There was a median
Discussion
It is an understandable concern of the trauma surgeon that an ankle fracture that is immobilised in plaster may displace to an unacceptable degree. This is a particular concern in Weber B fractures since the standard radiographs are not able to distinguish an intact deltoid ligament from a complete rupture. Lauge-Hansen3 described these fracture types as supination external rotation (SE) injuries, referring to the mechanism of injury. It helps to consider this classification when treating ankle
Acknowledgements
We wish to thank all consultant orthopaedic surgeons (Messrs S. Chugh, A.M. Fraser, E. Isbister, A. Thomas, R.J. Thomas and S. Turner at the Royal Wolverhampton Hospital for allowing their patients to be involved in this research.
References (10)
Is closed treatment ankle fractures advisable
Acta Orthop. Scand.
(1985)- et al.
Closed treatment of ankle fractures
Acta Orthop. Scand.
(1985) - Lauge-Hansen, Classification of ankle fractures. Ankelbrud...
Lauge-Hansen or AO system?
CORR.
(1985)Lateral malleolar fracture requires no treatment
Acta Orthop Scand
(1992)
Cited by (30)
Functional bracing is a safe and cost effective treatment for isolated Weber B fracture
2021, FootCitation Excerpt :The results are shown in Table 2. There is a growing consensus among foot and ankle surgeons to support that trans-syndesmotic distal fibula fractures without medial column injury are stable fractures and could be safely treated by functional bracing and early weight bearing [10–12]. This consensus was further strengthened by the findings of the recently published Combined Randomised and Observational Study of Surgery for type-B Ankle Fracture Treatment [CROSSBAT] [13] and the British Orthopaedic Association Standards for Trauma [BOAST] guidelines published in 2016 [14].
The acute management of ankle fractures (Augment) study: A prospective trainee led national collaborative audit of the Boast 12 guidelines
2021, SurgeonCitation Excerpt :This incidence is comparable to a large retrospective study of ankle injuries, where VTE was diagnosed in 0.38% of patients with 65% of those affected not having received chemical prophylaxis.19 Patients with stable ankle fractures often receive numerous fracture clinic appointments20 and have serial radiographs taken which have little impact on fracture management.21 BOA guidance suggests patients with an acute orthopaedic injury are reviewed in a fracture clinic within 72 h of presentation.22
Orthopedic treatment and early weight-bearing for bimalleolar ankle fractures in elderly patients: Quality of life and complications
2020, InjuryCitation Excerpt :This meta-analysis also finds no significant difference between the included studies; however, some of them do not report complications [30,31]. In this study, the complications and, therefore, radiographs stopped being assessed at 6–8 weeks to know if tests of forced external rotation were used in these patients and to say that there are studies that question whether more routine radiographs would be needed [32]. Some of these studies use unprotected load [8].
Trauma assessment clinic: Virtually a safe and smarter way of managing trauma care in Ireland
2019, InjuryCitation Excerpt :There is an increasing body of evidence to support the promotion of patient “self-care”, early mobilisation and reduced follow-up for certain fracture types (See Table 1) [13–21]. Maintenance of patient safety, good functional outcomes and high satisfaction levels have also been revealed with some patients preferring the optional or no follow-up route [13,15–18,20–30]. More recently, studies from centres with established VFC’s, reveal a safe and robust patient pathway with good functional outcomes and patient satisfaction [3,31–36].
Weightbearing Radiographs Facilitate Functional Treatment of Ankle Fractures of Uncertain Stability
2015, Journal of Foot and Ankle Surgery