title: Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures.
abstract: BACKGROUND
  Treatment of ankle fractures is often based on fracture type and surgeon's individual judgment. Literature concerning the treatment options and outcome are dated and frequently contradicting. The aim of this study was to determine the clinical and functional outcome after AO-Weber B-type ankle fractures in operatively and conservatively treated patients and to determine which factors influenced outcome.
  
  
  METHODS
  A retrospective cohort study in patients with a AO-Weber B-type ankle fracture. Patient, fracture and treatment characteristics were recorded. Clinical and functional outcome was measured using the Olerud-Molander Ankle Score (OMAS), the American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS) and a Visual Analog Score (VAS) for overall satisfaction (range 0-10).
  
  
  RESULTS
  Eighty-two patients were treated conservatively and 103 underwent operative treatment. The majority was female. Most conservatively treated fractures were AO-Weber B1.1 type fractures. Fractures with fibular displacement (mainly AO type B1.2 and Lauge-Hansen type SER-4) were predominantly treated operatively. The outcome scores in the non-operative group were OMAS 93, AOFAS 98, and VAS 8. Outcome in this group was independently negatively affected by age, affected side, BMI, fibular displacement, and duration of plaster immobilization. In the surgically treated group, the OMAS, AOFAS, and VAS scores were 90, 97, and 8, respectively, with outcome negatively influenced by duration of plaster immobilization.
  
  
  CONCLUSIONS
  Treatment selection based upon stability and surgeon's judgment led to overall good clinical outcome in both treatment groups. Reducing the cast immobilization period may further improve outcome.
authors.affiliation: Department of Emergency Medicine, Reinier de Graaf Groep Delft, Delft, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: Van Schie-Van der Weert
authors.forename: E M M
authors.initials: EM
authors.lastname: Van Lieshout
authors.forename: M R
authors.initials: MR
authors.lastname: De Vries
authors.forename: M
authors.initials: M
authors.lastname: Van der Elst
authors.forename: T
authors.initials: T
authors.lastname: Schepers
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000145:classification / Q000601:surgery / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome