Management of Weber B Ankle Fractures: What have We Learnt since the CROSSBAT Trial?
Sriskandarasa Senthilkumaran, Andrew Oppy, Harvinder Bedi
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.
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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