Midterm Follow-up of a Novel Algorithm for Nonoperative Weber B Ankle Fractures

Abstract

Background: Stable Weber B ankle fractures are routinely treated nonoperatively. Our group previously presented a novel algorithm that provides radiographic parameters guiding when Weber B ankle fractures can be treated nonoperatively.² The purpose of this study is to evaluate the durability of those results with a minimum 5-year follow-up.

Methods: All 51 patients who were included in the initial study were contacted by telephone and asked to return to clinic for repeat evaluation where American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot, Olerud-Molander Ankle (OMA), and visual analog scale (VAS) scores were collected. Bilateral standing ankle radiographs were obtained and evaluated using the Kellgren-Lawrence grading scale for ankle arthritis.

Results: Twenty-nine of 51 patients (56%) participated in this follow-up study with a mean follow-up of 6.8 (range 5.6-8) years. Average functional score results were as follows: AOFAS, 98.43; OMA score, 94.11; and VAS, 0.46. AOFAS scores improved by an average of 5 points between 1 year and 5 years (P = .002); OMA and VAS scores were stable. All patients achieved union of their fracture on follow-up radiographs.

Conclusion: Our findings demonstrate the durability of the previous study results conducted by Holmes et al,² and support that appropriately selected patients can be treated nonoperatively using the study's novel algorithm. This reinforces our theory that medial clear space widening on weightbearing radiographs up to 7 mm should be considered for nonoperative management.

Level of evidence: Level IV, case series.

Keywords: Weber B; ankle fracture; nonsurgical treatment; radiography.