Functional bracing safe and cost effective treatment for isolated Weber B fracture: Study

Despite the current recommendations that stable Weber B ankle fractures can be treated with functional bracing and weight bearing as tolerated, some reluctance exists among trauma surgeons to follow these recommendations. The paper by Ahmed Abdelaal & Sherif Elnikety reports on their institution's experience in managing these injuries and compares it to the national guidelines.

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

Results:

• 123 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 six months.

• 62 were treated in plaster and was 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 immobilisation or weight bearing 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.

The authors concluded that - in the absence of clinical and radiological evidence of instability, Weber B trans-syndesmotic isolated fractures could be treated safely with functional bracing and early weight bearing. They also recommend the use of weight bearing radiographs in the first outpatient appointment as a reliable method to confirm ankle stability. Their recommendations are in line with the current guidelines.

Further reading:

Functional bracing is a safe and cost effective treatment for isolated Weber B fracture

Ahmed Abdelaal, Sherif Elnikety

The Foot 49 (2021) 101839

https://doi.org/10.1016/j.foot.2021.101839