Type B ankle fractures: a retrospective study of longer-term outcomes

Comparison of operatively and nonoperatively treated isolated Weber B ankle fractures: a systematic review and meta-analysis

BACKGROUND

Despite fractures of Isolated Weber B being prevalent, there is a lack of clarity regarding the relative effectiveness of surgical versus conservative treatment. This systematic review and meta-analysis aimed to investigate the clinical effects and complications of surgical versus conservative treatment of the Isolated Weber B ankle fractures.

METHODS

This study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on Isolated Weber B ankle fractures repaired through surgical versus conservative treatment. Through a comprehensive meta-analysis, several outcomes were evaluated, including post-operative function, complications and reoperation rate.

RESULT

Six articles involving 818 patients who met the inclusion criteria. Among these participants, 350 were male and 636 were female. 651 patients received conservative treatment, while 396 underwent surgical intervention. The findings indicate no significant differences in OMAS, FAOQ, PCS, MCS scores, and return to work between surgical and non-surgical treatments for isolated Weber B ankle fractures. However, compared with surgical treatment, non-surgical treatment has a higher AOFAS score(MD = -5.31, 95% CI = [-9.06, -1.55], P = 0.20, I2 = 39%), lower VAS score(MD = 0.72, 95% CI = [0.33, 1.10], P = 0.69, I2 = 0%), lower complication rate (RR = 3.06, 95% CI = [1.58, 6.01], P = 0.05, I2 = 54%), and lower reoperation rate(RR = 8.40, 95% CI = [1.57, 45.06], P = 0.05, I2 = 67%).

CONCLUSION

Patient reported outcomes following non-operatively managed Weber Type A distal fibula fractures

INTRODUCTION

The outcomes of "Weber A" type fibula fractures treated non-operatively are not well studied. The aims of this study were to investigate patient reported outcomes (PROMs) from such injuries and investigate if different radiological features of the fracture affects such outcomes.

METHODS

Patients with conservatively managed Weber A fractures were contacted retrospectively (minimum 11 months) to measure PROMs. PROMs included the use of the Chertsey Outcome Score for Trauma (COST) as well as the time to return to work, physical activity and time to become symptom free. The effect of fracture features such as fracture height and intra-articular extension were analysed for their effect on PROMs.

RESULTS

Data was collected from 72 patients from a total of 211 patients presenting with Weber A fractures. The mean COST scores were 83 (range 30-100). Patients reported on average 3.1 weeks (desk based) and 5.7 weeks (labour intensive) to return to work, 10.8 weeks to return to physical activity and 14.8 weeks to become symptom free with 21% of patients still symptomatic at follow-up. Fracture height and fractures with comminution, displacement, intra-articular extension did not appear to be associated with poorer PROMs.

CONCLUSION

The outcomes are generally excellent; however, most patients do not return to their baseline before the injury, with a significant proportion of patients remaining symptomatic at follow-up. The reported times to return to work, physical activity and symptom-free are useful to manage patient expectations. Our results dispel any assumption that Weber A type distal fibula fractures are always associated with excellent outcomes.