Low Risk of Displacement with Early Weight Bearing of the Isolated Weber B Fracture: Results of a New Treatment Protocol

CATEGORY: Trauma; Ankle INTRODUCTION/PURPOSE: Truly isolated Weber B distal fibula fractures are stable injuries that usually recover well following non- operative treatment, however the concern over the possibility of a medial ligament injury, and ankle instability has traditionally lead to regular surveillance in the fracture clinics to exclude delayed talar shift developing. After recent studies suggesting this risk is low we introduced a new functional treatment protocol and present our early results. METHODS: 141 consecutive patients presenting acutely with isolated Weber B fractures without talar shift during a 12 months period were included. ED notes and radiographs were reviewed. All patients were splinted in a removable boot, and allowed to fully weight bear up to their comfort levels. Patients without signs of a medial ligament injury were then discharged from follow-up with advice to wear the boot for 6 weeks, an information leaflet and exercise sheet and a helpline number in case of difficulties. If they wanted clinic review this was organised. If signs of a medial ligament injury were documented, or the medial findings were not clear the patient was reviewed with up to date radiographs in the fracture clinic at 4 weeks post-injury. If talar shift developed the patient was to be converted to operative treatment. Olerud and Molander scores were collected between 6 and 12 months post- injury. RESULTS: There were 51 patients without signs of medial ligament injury and of these 23 were discharged according to protocol and 28 patients attended fracture clinic. 89 patients had signs of medial ligament injury or no documented medial findings and of these 65 attended fracture clinic. One discharged patient re-accessed care. Of 93 patients reviewed in the fracture clinic none developed delayed talar shift. One underwent delayed ORIF for ongoing fibula discomfort and the remainder continued with non- operative treatment. 99 (70%) patients provided outcome scores. The mean Olerud and Molander score at a minimum of 6 months follow-up was 87 and the median score was 100. No significant difference was found between treatment arms. The scores were comparable to those in the published literature. CONCLUSION: We conclude the risk of delayed talar shift is low and satisfactory outcomes can be safely achieved with our functional protocol. Additional tests/imaging to establish the integrity of the medial ligament may be unnecessary.