January 2022

FUNCTIONAL BRACING IS SAFE, COST EFFECTIVE FOR WEBER B FRACTURE

Figure. Treatment pathways for isolated Weber B fractures.

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. This paper reports on our institution’s experience in managing these injuries and compare it to the national guidelines.

Patients and methods: This is a retrospective cohort study. Consecutive patients with isolated Weber B fractures referred to the local outpatient clinic over the period of 6 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 immobilization, weight-bearing status, radiological fracture union, clinical outcomes and complications were all assessed and analyzed.

Results: One 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 6 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 immobilization 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 weight bearing was associated with fewer outpatient clinics and a reduced number of radiographs obtained in the clinic and fewer complications.

Conclusion: Isolated trans-syndesmotic Weber B ankle fractures, that are clinically and radiologically stable, can be safely treated with functional bracing in a boot and weight bearing as tolerated.

Abstract from: Abdelaal A, Elnikety S. Functional bracing is a safe and cost effective treatment for isolated Weber B fracture. The Foot. 2021;49:101839. Use is per CC BY 4.0.

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