A Novel Algorithm for Isolated Weber B Ankle Fractures: A Retrospective Review of 51 Nonsurgically Treated Patients

Abstract

IV.

Weight bearing cone beam CT scan versus gravity stress radiography for analysis of supination external rotation injuries of the ankle

“…With evaluation by weight-bearing radiographs, only three patients had MCS widening and the remainder were successfully treated non-operatively (4). Two case series have shown that when stability can be illustrated on weight-bearing radiographs, non-operative treatment can be expected to deliver good clinical outcomes (5,6). These studies provide evidence to support non-operative treatment as a cost containment strategy and to avoid the morbidity and complications known to be associated with operative management of these fractures.…”

“…Because our patients were allowed to rest the healthy leg on the CT ring housing, and were allowed to use the two arm handles of the device for balance and support during the CT scan, true full weight bearing may not have been achieved. Other studies have demonstrated approximately 5-10% rate of instability demonstrated on weight-bearing radiographs, so it is estimated that it would take 10 to 20 patients to find 1 unstable fracture on weight-bearing CBCT scan (4,5). We recognize that by the nature of our study requiring our patients to bear weight on a fractured ankle, we may have selected the most stable of the ankles, which simply confirmed stability with the weight-bearing CBCT and limits the generalizability of the study results.…”

“…Others have advocated for the use of weight-bearing radiographs, because gravity stress radiographs might overestimate the number of unstable ankle fractures (3)(4)(5)(6)(7)18). In these studies, weight-bearing radiographs have been shown to be predictive of stability, and patients with a normal mortise relationship can be successfully managed with immediate protected weight-bearing and functional treatment.…”

“…Undisplaced or minimally displaced lateral malleolus fractures without medial injury are likely to be stable, and can be treated non-operatively with functional bracing and early mobilization (3)(4)(5)(6)(7). Lateral malleolar fractures with medial injury may be unstable, and are more frequently treated by operative reduction and internal…”

Tratamento da lesão da sindesmose tibiofibular distal associada às fraturas do tornozelo com suture button

“…3 8 10 11 As radiografias nas incidências anteroposterior (AP), perfil e mortise (AP com 15° de rotação interna) são necessárias para confirmar o diagnóstico da fratura do tornozelo e avaliar a ocorrência de lesão da sindesmose mediante a identificação de alterações como fratura-avulsão da sindesmose, fratura alta da fíbula (Weber tipo C ou de Maisonneuve), abertura do espaço claro medial > 4mm, alterações da sobreposição e do espaço claro tibiofibular e a integridade do maléolo posterior. 7 12 A TAC auxilia na avaliação da posição relativa entre a tíbia e a fíbula, no melhor entendimento das fraturas do maléolo posterior possivelmente associadas e na realização do diagnóstico de fraturas ocultas. Em até 40% dos casos, o plano de tratamento pode mudar após estudo das imagens da TAC.…”