title: Weightbearing Radiographs Facilitate Functional Treatment of Ankle Fractures of Uncertain Stability.
abstract: The most important determinant in the treatment of malleolar fractures is stability. Stable fractures have an intact deep deltoid ligament and do not displace with functional treatment. If the deep deltoid/medial malleolar complex is disrupted, the talus is at risk of displacement. Weber (2010) showed that weightbearing radiographs predicted stability in patients with undisplaced ankle fractures. We developed clinical criteria for potential instability and applied them to a prospective series of patients. The criteria included a medial clear space of <4 mm; medial tenderness, bruising or swelling; a fibular fracture above the syndesmosis; a bimalleolar or trimalleolar fracture; an open fracture; and a high-energy fracture mechanism. A prospectively documented series of 43 patients chose functional brace treatment of the potentially unstable fractures. Weightbearing radiographs were performed with the patient wearing the brace before treatment and free of the brace at clinical union (6 to 9 weeks for all patients). The patients were encouraged to bear full weight and actively exercise their ankles in the brace. All fractures healed without displacement. The risk of displacement was 0% (95% confidence interval 0% to 9.5%). The results of the present preliminary series give support for the use of weightbearing radiographs to guide treatment of undisplaced ankle fractures.
authors.affiliation: Speciality Registrar, Department of Trauma and Orthopaedic Surgery, Royal Blackburn Hospital, Blackburn, Lancashire, United Kingdom. Electronic address: grhastie@doctors.org.uk.
authors.forename: Graham Ross
authors.initials: GR
authors.lastname: Hastie
authors.affiliation: Speciality Registrar, Department of Trauma and Orthopaedic Surgery, Royal Blackburn Hospital, Blackburn, Lancashire, United Kingdom.
authors.forename: Sabeen
authors.initials: S
authors.lastname: Akhtar
authors.affiliation: Speciality Registrar, Department of Trauma and Orthopaedic Surgery, Royal Blackburn Hospital, Blackburn, Lancashire, United Kingdom.
authors.forename: Usman
authors.initials: U
authors.lastname: Butt
authors.affiliation: Speciality Registrar, Department of Trauma and Orthopaedic Surgery, Royal Blackburn Hospital, Blackburn, Lancashire, United Kingdom.
authors.forename: Andreas
authors.initials: A
authors.lastname: Baumann
authors.affiliation: Consultant, Department of Trauma and Orthopaedic Surgery, Royal Blackburn Hospital, Blackburn, Lancashire, United Kingdom.
authors.forename: James L
authors.initials: JL
authors.lastname: Barrie
mesh_terms: D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D016512:Ankle Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D000843:Ankle Joint / Q000000981:diagnostic imaging; D001915:Braces; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D016474:Weight-Bearing
keywords: fibula; ligament; malleolus; stability; talus; tibia; weightbearing