Prospective randomized controlled trial: early weight bearing after conservative treatment of Weber B ankle fractures (pancake trial)

Abstract

Purpose Different studies have shown that weightbearing is safe in stable transsyndesmotic, isolated lateral simple ankle fractures. Despite this evidence, AO guidelines still recommend immobilization with above-the-knee cast for 4–6 weeks for these fractures. The objective of this study was to compare the outcomes of mobilization and weightbearing to those of immobilization and non-weightbearing in patients with stable transsyndesmotic, lateral isolated simple ankle fractures. Methods Fifty patients were randomly assigned to permissive weightbearing in a walking boot or non-weightbearing immobilization using a below-the-knee cast. Primary outcome was ankle functionality as scored by the Olerud-Molander Ankle Score (OMAS). Secondary outcomes were radiological displacement of fracture, range of motion (ROM), calf circumference, and RAND 36-item health survey. Patients were in follow-up for 24 months. Results Ankle functionality after six and twelve weeks was significantly higher for the intervention group, with respectively 30 points (p = 0.001) and 10 points (p = 0.015) of difference. ROM improved significantly in the intervention group after six weeks. All fractures showed radiological progression of fracture healing. RAND 36-item showed differences in both physical (60.3 vs. 46.3, p = 0.017) and mental (78.5 vs. 58.2, p = 0.034) components in favor of the intervention group. In 16% of patients who initially showed stable fractures on radiographic imaging, joint dislocation was identified on weightbearing radiographs prior to randomization, leading to exclusion. Conclusion Weightbearing and mobilization using a walking boot may be a safe treatment for patients with stable Weber B fractures.

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

“…The findings supported a limited use of implants in osteosynthesis as being reasonable. Stassen et al [ 29 ] applied a walking boot as a method of conservative treatment for 50 patients diagnosed with stable Weber B fractures, achieving satisfactory outcomes. Evidence from both randomized and non-randomized controlled trials suggests that conservative management of stable ankle fractures yields favorable outcomes in the short and long term.…”

Permissive Weight Bearing in Patients With Surgically Treated Periprosthetic Femoral Fractures Around Total Hip Arthroplasty: A Scoping Review

“…Second, PWB promotes improved mobility and functional recovery [ 10 , 11 ]. Patients can regain independence more quickly, which can lead to a positive impact on their overall quality of life [ 14 ]. Third, controlled weight bearing can stimulate bone healing and remodeling by promoting physiological stress on the fracture site [ 25 , 26 ].…”

“…However, PWB is not a commonly used postoperative weight-bearing protocol, and there is no consensus on its use in the aftercare of PPFF around THA [12]. The term PWB was first described by Kalmet et al [13] and is now increasingly described in the literature and applied in clinical postoperative weight-bearing treatment protocols [14]. PWB involves advancing the weight-bearing process based on the patient's and therapist's subjective observations, such as pain levels and the patient's ability to tolerate weight-bearing, while also taking into account objective factors like limb temperature, swelling, and gait metrics [13].…”