Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 8 , ISSUE 4 ( October-December, 2021 ) > List of Articles

Symposium: Complex Injuries Around The Ankle

Management of Weber B Ankle Fractures: What have We Learnt since the CROSSBAT Trial?

Sriskandarasa Senthilkumaran, Andrew Oppy, Harvinder Bedi

Keywords : Ankle stability, Combined randomized and observational study of surgery for type B ankle fracture treatment, Nonoperative management, Post-traumatic arthrosis, Weber B ankle fracture, Weight-bearing radiograph

Citation Information : Senthilkumaran S, Oppy A, Bedi H. Management of Weber B Ankle Fractures: What have We Learnt since the CROSSBAT Trial?. J Foot Ankle Surg Asia-Pacific 2021; 8 (4):158-161.

DOI: 10.5005/jp-journals-10040-1168

License: CC BY-NC 4.0

Published Online: 20-10-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Weber B fractures account for about 50% of all fractures at the ankle joint. Despite being a common injury, there is clinical equipoise in the management of an isolated lateral malleolar fracture with presumed medial ligamentous injury. The Combined Randomized and Observational Study of Surgery for type B Ankle fracture Treatment (CROSSBAT) study was a multicenter randomized control trial that also had an observational cohort arm. It showed that nonoperative management of Weber B fractures produced equivalent functional results at 1 year and avoided risks and complications that are associated with operative treatment. Other studies have shown similar results in short to mid-term follow-ups. The key to decision-making in ankle fracture is evaluating the stability of the ankle mortice. Weight-bearing radiographs are gaining popularity in this assessment as we understand the important role of the deep deltoid ligament. A lateral malleolar fracture with a medial ligamentous injury that is deemed to be stable by weight-bearing X-rays can be safely managed nonoperatively. Long-term studies are needed to calculate the relative risk of developing post-traumatic arthrosis in these patients compared to those who underwent fixation.


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  1. Dattini R, Patnaik S, Kantak A, et al. Injuries to tibiofibular syndesmosis. J Bone Joint Surg 2008;90–B(4):405–410. DOI: 10.1302/0301-620X.90B4.19750.
  2. Donken CC, Al-Khateeb H, Verhofstad MH, et al. Surgical versus conservative interventions for treating ankle fractures in adults. Cochrane Database Syst Rev 2012(8):CD008470. DOI: 10.1002/14651858.CD008470.pub2.
  3. Weber BG. Die Verletzungen Des Oberen Sprung-Gelenkes. 2nd ed., Berne: Verlag Hans Huber; 1972.
  4. Müller ME, Allgöwer M, Schneider R, et al. Manual of internal fixation: techniques recommended by the AO group. 2nd ed., Ch. 14, Berlin: Springer-Verlag; 1979. pp. 595–612.
  5. Larsen P, Rathleff MS, Elsoe R. Surgical versus conservative treatment for ankle fractures in adults - a systematic review and meta-analysis of the benefits and harms. Foot Ankle Surg 2019;25(4):409–417. DOI: 10.1016/j.fas.2018.02.009.
  6. Julian TH, Broadbent RH, Ward AE. Surgical vs non-surgical management of Weber B fractures: a systematic review. Foot Ankle Surg 2020;26(5):494–502. DOI: 10.1016/j.fas.2019.06.006.
  7. Lin CW, Donkers NA, Refshauge KM, et al. Rehabilitation for ankle fractures in adults. Cochrane Database Syst Rev 2012;11:CD005595. DOI: 10.1002/14651858.CD005595.pub3.
  8. Mittal R, Harris IA, Adie S, et al. Surgery for type B ankle fracture treatment: a combined randomised and observational study (CROSSBAT). BMJ Open 2017;7(3):e013298. DOI: 10.1136/bmjopen-2016-013298.
  9. Sanders DW, Tieszer C, Corbett B. Canadian orthopedic trauma society. Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial. J Orthop Trauma 2012;26(3):129–134. DOI: 10.1097/BOT.0b013e3182460837.
  10. Willett K, Keene DJ, Mistry D, et al. Close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults: a randomized clinical trial. JAMA 2016;316(14):1455–1463. DOI: 10.1001/jama.2016.14719.
  11. Keene DJ, Lamb SE, Mistry D, et al. Three-year follow-up of a trial of close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults. JAMA 2018;319(12):1274. DOI: 10.1001/jama.2018.0811.
  12. Michelson JD, Ahn UM, Helgemo SL, et al. Motion of the ankle in a simulated supination-external rotation fracture model. JBJS 1996;78A(7):1024–1031. DOI: 10.2106/00004623-199607000-00006.
  13. Gill JB, Risko T, Raducan V, et al. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. J Bone Joint Surg Am 2007;89(5):994–999. DOI: 10.2106/JBJS.F.01002.
  14. Seidel A, Krause F, Weber M. Weight bearing vs gravity stress radiographs for stability evaluation of supination-external rotation fractures of the ankle. Foot Ankle Int 2017;38(7):736–744. DOI: 10.1177/1071100717702589.
  15. Hastie GR, Akhtar S, Butt U, et al. Weight bearing radiographs facilitate functional treatment of ankle fractures of uncertain stability. J Foot Ankle Surg 2015;54(6):1042–1046. DOI: 10.1053/j.jfas.2015.04.025.
  16. Dawe EJ, Shafafy R, Quayle J, et al. The effect of different methods of stability assessment on fixation rate and complications in supination external rotation (SER) 2/4 ankle fractures. Foot Ankle Surg 2015;21(2):86–90. DOI: 10.1016/j.fas.2014.09.010.
  17. Weber M, Burmeister H, Flueckiger G, et al. The use of weight bearing radiographs to assess the stability of supination-external rotation fractures of the ankle. Arch Orthop Trauma Surg 2010;130(5):693–698. DOI: 10.1007/s00402-010-1051-1.
  18. Lampridis V, Gougoulias N, Sakellariou A. Stability in ankle fractures: diagnosis and treatment. EFORT Open Rev 2018;3(5):294–303. DOI: 10.1302/2058-5241.3.170057.
  19. Gougoulias N, Sakellariou A. When is a simple fracture of the lateral malleolus not so simple? How to assess stability, which ones to fix and the role of the deltoid ligament. Bone Joint J 2017;99-B(7):851–855. DOI: 10.1302/0301-620X.99B7.BJJ-2016-1087.R1.
  20. Lübbeke A, Salvo D, Stern R, et al. Risk factors for post-traumatic osteoarthritis of the ankle: an eighteen year follow-up study. Int Orthop 2012;36(7):1403–1410. DOI: 10.1007/s00264-011-1472-7.
  21. Müller J, Plaass U, Willenegger HII. Spätergebnisse nach operativ behandelten malleolar frakturen [Late results after surgically treated malleolar fractures. II]. Helv Chir Acta 1971;38(3):329–337.
  22. Beris AE, Kabbani KT, Xenakis TA, et al. Surgical treatment of malleolar fractures. A review of 144 patients. Clin Orthop Relat Res 1997(341):90–98. DOI: 10.1097/00003086-199708000-00015.
  23. Rooney EM, Finney FT, Talusan P, et al. Mid term 5-year follow up of a novel algorithm for non-operative Weber B ankle fractures. Foot Ankle Orthop 2019(5). DOI: 10.1177/2473011419S00366.
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