Ankle Fractures:Supination-Eversion Fractures Stage II Primary and Late Results of Operative and Non-Operative Treatment

Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial

“…28 29 However, possibly due to absence of high quality evidence on the effectiveness and safety of more simple non-operative treatment strategies, the current tenet of six weeks of cast immobilisation coupled with a series of follow-up radiographs—even weekly48—still remains the ideal treatment of stable Weber B type fractures 819 20 22 23 This is based primarily on bioplausibility—experimental studies showing that it takes six weeks for any fracture to reach a sufficient strength to resist weightbearing induced strains49—and evidence from clinical trials showing satisfactory outcomes in patients with minimally or non-displaced Weber B type fibula fractures 1617 18 19 It thus seems that although most Weber B type fibula fractures are stable and do not require plaster casting to achieve fracture union in a good position, orthopaedic surgeons value aversion of potential fracture displacement over the risks of prolonged immobilisation, including stiffness, skin damage, and thromboembolism.…”

“…Traditionally, the assessment of the stability of the ankle mortise in patients with an isolated fibula fracture has relied on plain radiography and consensus based indicators for instability: fracture gap more than 2 mm, particularly when complemented with “red flag” clinical findings on the medial side of the ankle (tenderness, swelling, haematoma) 1617 18 24 27 28 29 30 Occasional cases of treatment failures—widening of the ankle mortise—has been associated with this treatment strategy 1618 28 In our trial, we used external rotation stress testing, a method gaining popularity,6 7 8 9 11 12 13 14 15 to confirm the stability of the ankle mortise immediately after the injury.…”

“…3 4 5 6 7 8 These fractures can be either stable or unstable depending on the accompanying soft tissue injury 67 8 9 10 11 12 13 14 15 16 The stability of the ankle mortise has fundamental clinical relevance, as it dictates the treatment strategy 67 8 9 10 11 12 13 14 15 16 Stable ankle fractures can be treated non-surgically7 8 16 17 18 19 20 and account for about half of ankle fractures 1…”

“…In keeping with this belief, the traditional non-operative treatment of a stable Weber B type fracture is a below-the-knee cast for six weeks 816 17 18 19 20 21 22 Abundant evidence confirms that this strategy leads to a high rate of fracture union,16 17 18 19 20 21 22 but it is associated with harms, such as increased ankle stiffness and deep vein thrombosis 2123 24 25 26 Awareness of this trade-off between benefits and harms has been a catalyst towards considering shorter, more functional and less bothersome non-operative strategies that would still result in successful fracture healing 24…”

Anatomy, pathomechanics, and classification of ankle fractures

“…Die Refixation größerer, die gesamte Breite des Innenknöchels einnehmender Frakturen ("suprakollikuläre Frakturen" nach Pankovich,[28]) hingegen stabilisiert die kräftige,tiefe Portion des Ligamentum deltoideum. Klinische Studien mit Beobachtungszeiträumen von bis zu 30 Jahren bestätigen die experimentell gewonnenen Erkenntnisse, indem sie für isolierte Fibulafrakturen sehr gute Ergebnisse bei konservativ-funktioneller Therapie nachwiesen [1,16,37,48], während wiederholt gezeigt werden konnte, dass bei Bimalleolarfrakturen die operative Therapie deutlich bessere Resultate erzielen lässt [31,32,49].…”