Non operative management of common fractures author. Weber b ankle fractures were defined as stable when having a medial clear space mcs of oct 28, 2011 a 73 year old woman presented to the accident and emergency department after having fallen down a flight of stairs near her local shops. After her fall she sustained a closed injury to her left ankle, which was swollen and painful to. Over five million ankle injuries occur each year in the united states alone. This allows locomotion and balance on both level and uneven ground.
The nonoperative treatment of weber b type ankle fractures and. Lateral malleolar fracture displaced weber b weber c bimalleolar avhap educational talk 28 june 2011, duy thai. Danisweber classification of ankle fractures physiopedia. Methods a pragmatic, multicentre, singleblinded, combined randomised controlled trial and observational study. The malleolar fracture usually starts medially at the level of the talar dome, but can also start a few centimeters above this level. There were no significant differences identified between surgical and nonsurgical management of weber b fractures with respect to functional outcome. A 73 year old woman presented to the accident and emergency department after having fallen down a flight of stairs near her local shops. Background isolated type b ankle fractures with no injury to the medial side are the most common type of ankle fracture. Fracture orientation not purely in coronal plane nearly always associated with the pull of the posterior tibfib ligament larger laterally than medially obliquely oriented involves the incisura haraguchi et al. Two commonly used classification systems for ankle fractures include the danis weber ao. May 23, 2014 fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year.
Stabilitybased classification for ankle fracture management and the syndesmosis injury in ankle fractures due to a supination external rotation mechanism of injury harri pakarinen from the division of orthopedic and trauma surgery, department of surgery, oulu university hospital, university of oulu oulu, finland. Jan 20, 2016 the laugehansen lh classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury. This fracture classification system, based on the level of the fibular fracture in relation to the ankle joint, can help determine which injuries are likely to require surgical intervention. The weber ankle fracture classification or danisweber classification is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint. The secondary aim was to gain insight in various factors influencing outcome. A weber a is a simple fracture to the bottom part of the fibula bone on the outer part of your leg.
Indications for operative treatment of ankle fractures are dictated by the stability. Weber a fracture this information will guide you through the next 6 weeks of your rehabilitation. These fractures may be referred to as a weber fracture and are classified as a, b or c dependent on the site of the break see below. Weber b fracture v1 this information will guide you through the next 6 weeks of your rehabilitation. Jan 23, 2019 objective to determine whether treatment of isolated stable weber b type ankle fractures with a cast or a simple orthotic device for three weeks produces noninferior outcomes compared with conventional immobilisation in a cast for six weeks.
Here, we report a case of a 32yearold male who sustained a weber b fracture of the lateral. Weber b fractures stable if undisplaced and mortice. For a good longterm functional outcome to be achieved, reliable early evaluation is crucial so that it can be determined whether the problem is a distorsion sprain, ligament rupture, bony ligament avulsion, or fracture of the talocrural joint. Fractures of the ankle joint are common amongst adults. If the fracture starts at the ankle and runs proximal to the joint it is a weber b, if the fracture of the fibula is above the syndesmosis the fracture is classified as weber c. The anatomical classification of weber categorises fractures according to the site of the injury with type b being at the level of the syndesmosis and accounting for up to 50% of these injuries. Classification type a below level of the ankle joint tibiofibular syndesmosis intact deltoid ligament intact medial malleolus often fractured usually stable, although occasionally requires open reduction and internal fixation orif type b at the level of. Ankle fracture weber b east sussex healthcare nhs trust. Using weightbearing radiographs, a reliable method to determine the stability of isolated weber b ankle fractures is described.
Sep 30, 2011 the gray area of treatment lies mainly with the minimally displaced weber b type ankle fractures. Weber b fracture of the lateral malleolus with concomitant. Stage 2 oblique fracture of the fibula this is the true weber b fracture. The typical weber b ankle fracture is caused by an ser mechanism according to the laugehansen classification. There are many different types of fractures of the ankle. Weber classification of ankle fractures dr jeremy jones and assoc prof frank gaillard et al. Setting two major trauma centres in finland, 22 december. The laugehansen lh classification attempts to predict patterns of ankle injuries based upon the preceding mechanism of injury. The aim of this study was to evaluate the management of radiographically stable weber b ankle fractures using a standardised treatment protocol in a virtual fracture clinic setting, to assess. In isolated stable weber b type ankle fractures, immobilization for 3 weeks with a cast or orthosis was noninferior to cast immobilization for 6 weeks for outcomes at 1 year. Three week versus six week immobilisation for stable weber b type. Surgical vs nonsurgical management of weber b fractures.
Cigarette smoking and a high body mass index have been associated with ankle fractures 5,6. Design randomised, pragmatic, noninferiority, clinical trial with blinded outcome assessment. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. The weber classification is simple, reliable, and reproducible, and thus it has been utilized routinely by emergency physicians. Manual stress requires time and more radiation exposure. A fracture is an interruption of the continuity of bone, this page will discuss ankle and foot fractures and the role that physiotherapists play in the rehabiliation of such injuries. Over the last 15 years in practice, i have progressed in my treatment of stable unimalleolar weber b ankle fractures from 6 weeks of nonweightbearing with a cast to a protocol of 3 weeks of partial weightbearing with a belowtheknee fracture boot and crutch gait assistance with transition at 3 weeks to full weightbearing with the use of.
Two commonly used classification systems for ankle fractures include the danis weber. This normally takes approximately 6 weeks to unite heal although pain and swelling can be ongoing for 36 months. Ankle fractures are increasingly common injuries that necessitate a careful approach for proper management. Syndesmotic injury may occur in isolation or may be associated with ankle fracture. In isolated stable weberb type ankle fractures, immobilization for 3 weeks with a cast or orthosis was noninferior to cast immobilization for 6 weeks for outcomes at 1 year van dijk, c. Fracture of the lateral malleolus distal to the syndesmosis the connection between the distal ends of the tibia and fibula.
Understanding risks and complications in the management of ankle fractures. Weber b fractures however, represent an area of greater controversy, with the best management and the circumstances determining management decisions yet to become clear. Stable fractures, where the alignment of the ankle joint is preserved, rarely need surgery. Check for tenderness of the medial malleolus to test if the deltoid ligament is ruptured. The ankle fracture management system was developed to be the most comprehensive set available for the treatment of common ankle fracture injuries. Ankle fracture weber b ankle 3 east sussex healthcare. The break may be below, at the same level or above your ankle joint. You have sustained a fracture to your fibula outside ankle bone. The weber classification describes ankle fractures according to their location. Lateral malleolar fracture displaced weber b weber c bimalleolar. When a surgeon addresses a weber b fracture, he is treating a fracture in the distal fibula, which is coded as a lateral malleolar fracture 824. Fracture management overview history who, what, when, where, why o who age, job, hobbies, hand dominance if hand involved, cognition amts score if elderly o what happened and exactly how it happened mechanism of injury force involved likelihood of other structure damage o when it happened o where it happened o why. C the fracture is proximal to the ankle joint with associated disruption of the syndesmosis to this level 10.
Pdf nonunion of distal fractures of the fibula type weber b is rare. After her fall she sustained a closed injury to her left ankle, which was swollen and painful to palpation over both malleoluses. Unstable fractures typically require closed reduction or open reduction and. Weber classification of ankle fractures radiology reference. Fibular fractures associated with an unstable ankle.
Fortunately, your fracture is minor and does not require an operation or plaster cast to treat it successfully. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Three week versus six week immobilisation for stable weber. Objective this study aimed to determine if surgery is superior to nonsurgical management for the treatment of these fractures. In the absence of fracture, physical examination findings.
A characterized by a transverse fibula fracture at or below the ankle joint and no syndesmotic injury. For a good longterm functional outcome to be achieved, reliable early evaluation is crucial so that it can be determined whether the problem is a distorsion sprain, ligament rupture, bony ligament avulsion, or fracture of the. There are similar fracture rates overall between women and men, but men have a higher rate as young adults, while women have higher rates in the 50 to 70year age group. Weber b fractures stable if undisplaced and mortice intact full below knee plaster with crutches re xray at 1 2 weeks plaster for 6 weeks total x ray at 6 weeks out of plaster clinical union no pain. Bmi of 38, established peripheral neuropathy, and his most recent hba1c is 8. The surgical priority in the management of unstable ankle fractures is to reestablish joint congruency and restore the anatomical ankle mortise. The oblique course of the fracture is typical for weber b and results from the exorotation of the talus that pushes against the fixed lateral malleolus. The primary aim of this study was to determine the outcome of operatively and conservatively treated patients with an aoweber btype ankle fracture. The most controversial ankle fracture is the weber b fracture in which the fibular or lateral malleolar fracture begins at the level of the ankle mortise and extends proximal and lateral. In conclusion, stable weber btype fibula fractures can safely be treated with only three weeks of cast immobilization or even with a simple orthosis. The danis weber classification1 weber classification is a simple method for classifying fractures of lateral ankle fractures and is based on radiographic criteria. According to laugehansen, it is the result of an exorotation force on the supinated foot.
Normal, uncomplicated followup care application of the first immobilization device, e. There is a higher rate of complication following surgical management, including infection, reoperation, thromboembolic events and death. The ser pattern of ankle fracture comprises up to 85% of all ankle fractures 12. Determinants of outcome in operatively and nonoperatively. What is the most appropriate definitive management option of figures b through f. Ankle fracture is one of the most common lower limb fractures for they account for 9% of all fractures representing a significant portion of the trauma workload. Weber b fractures stable if undisplaced and mortice intact full below knee plaster with. The danisweber classification often known just as the weber classification is a method of describing ankle fractures.
In isolated stable weberb type ankle fractures, immobilizat. A novel remedy for isolated weber b ankle fractures. Orthopedic surgeons often use terms in their dictation that dont appear in cpt, and weber b is one of those. Pdf standardised virtual fracture clinic management of. Conservative treatment of undisplaced or minimally displaced. Weber b type ankle fractures with a cast or a simple orthotic device for. Fracture of the proximal fibula indicative of syndesmotic injury. Stabilitybased classification for ankle fracture management.
Anteroposterior a and lateral b radiographic evaluation of the entire length of the fibula is essential to avoid missing a maisonneuve fracture and the associated syndesmotic injury. Reduce if displaced may be by open reduction, closed manipulation, or traction 3. Ankle fractures are the most commonly sustained fracture for patients between the ages of 20 and 65 with an incidence of almost 90 000 per year. Standardised virtual fracture clinic management of radiographically stable weber b ankle fractures is safe, cost effective and reproducible article pdf available in. Fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year. Ankle fractures are the most commonly sustained fracture for patients between the ages of 20 and 65. This is a transsyndesmotic fracture with usually partial and less commonly, total rupture of the syndesmosis. Figure 3 normal syndesmotic relationships include a tibiofibular clear space open arrows management.
The broken bone often occurs in just the fibula the thinner bone on the outside of your lower leg. The weber ankle fracture classification or danis weber classification is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint. Note the bimalleolar pattern with transverse fracture of the medial malleolus and oblique fracture of fibula beginning at the mortise. Objective to determine whether treatment of isolated stable weber b type ankle fractures with a cast or a simple orthotic device for three weeks produces noninferior outcomes compared with conventional immobilisation in a cast for six weeks. Ankle fractures usually affect young men and older women, however, below the age of 50. Weber b describes ankle fractures at the syndesmosis. Here, we report a case of a 32yearold male who sustained a weber b fracture of the lateral malleolus following a. Jbjs 2006 but other fracture patterns have also been defined. Stability of isolated weber b ankle fractures can be difficult to determine. The gray area of treatment lies mainly with the minimally displaced weber btype ankle fractures. The primary aim of this study was to determine the outcome of operatively and conservatively treated patients with an ao weber b type ankle fracture.
Retain to maintain position while healing occurs by internal fixation, external fixation, or conservative methods. The weber classification always refers to a distal fibular, or lateral. Diabetic ankle fractures with or without neuropathy risks. It is unclear whether these fractures should be managed surgically or not. Three week versus six week immobilisation for stable weber b. Operative versus non operative treatment for unstable. Please see the picture below to understand where this injury is. Feb 17, 2016 the ankle is a complex joint that is capable of a wide range of movement. Weber b ankle fractures were defined as stable when having a medial clear space.
This fracture can exist as isolated fractures of the lateral malleolus, or bimalleolar injuries in which both lateral and medial malleoli are fractured. B involves a spiral fibula fracture beginning at the level of the joint and a partial syndesmotic injury. Anteroposterior a and lateral b xrays demonstrating weber b fracture of the ankle. The general goals of fracture management are anatomic reduction of the fracture and protection of the soft tissue envelope. In conclusion, stable weber b type fibula fractures can safely be treated with only three weeks of cast immobilization or even with a simple orthosis. Understanding risks and complications in the management of. It takes into consideration the position of the distal fibular fracture in relation to the syndesmosis of the ankle joint.
Management fracture management stages include 4 rs. A novel algorithm for isolated weber b ankle fractures. The improved smallfragment implants and instruments, anatomic plates, and locking screw technology allow the effective treatment of the majority of ankle fracture patterns. The ankle takes the full weight of the body and is subject to considerable force, particularly in running and jumping. Although it is widely used in clinical practice, it has been criticized mainly due to numerous reports of cases conflicting the prediction system. Ankle syndesmotic injury abstract ankle syndesmotic injury does not necessarily lead to ankle instability. When an ankle fracture has been diagnosed, the choice of treatment. This is classified as a stable weber b type fracture.
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