4 August 2022 at 19:08:28
Weight bearing x ray (mortise and lateral views without boot or cast).
If stable then provide walking boot, crutches if needed, weight bear as tolerated.
If unstable - Reduce fracture, below knee backslab, post-backslab XR
If stable - On-line referral to VFC. If unstable - Refer to Ortho on-call
Info
Weber B fractures are distal fibular fractures at the level of the ankle syndesmosis. If this is isolated (ie. does not involve the medial malleolus) then it can be stable or unstable depending on the integrity of the syndesmosis and deltoid ligament. This can be determined by weight-bearing X-rays to look for talar shift.
Clinical presentation
Patient often has painful ankle and difficulty weight-bearing. Mechanism often involves a twisting injury of the ankle.
Clinical Signs / examination
The ankle may show bruising and swelling, with localised pain over the bony distal fibular. Ankle range of movement is often limited due to pain and swelling. Examining the medial side also is important to check the integrity of the deltoid ligament.
Investigations
XR of the ankle in AP and lateral is initially required for suspected ankle fracture.
If the initial ankle AP and lateral x-rays show an isolated weber B type ankle fracture without gross talar displacement, then a weight-bearing ankle mortise XR is required to "stress" the ankle under physiological conditions to look for talar shift.
To assess for lateral talar shift - look at the medial clear space (distance between talus and medial malleolus) and compare this with the superior clear space. (distance between articular surface of tibia and talus). If there is a significant widening of the medial clear space then the ankle is most likely unstable.
Management
Unstable Weber B fractures - require surgical fixation (refer to ortho on-call team).
Reduce the fracture and apply a below knee backslab.
Repeat ankle X-ray after reduction
Provide the patient crutches (if patient is going home to wait for surgery)
Instruct the patient on strict elevation and non-weight bearing (to help reduce swelling)
Ensure VTE prophylaxis is given
Pre-op preparations (e.g. COVID swabs, bloods tests if needed, contact details) The amount of tissue swelling determines when surgery can be done. Usually, surgery is within 1-2 weeks of injury.
Stable Weber B fracture - can be managed non-operatively. (refer to VFC).
Provide the patient a walking boot and instruct them to weight bear as tolerated. The walking boot should be worn when mobilsiing.
When not mobilising, the patient should remove the boot, elevate the ankle and perform range of movement exercises.
Our VFC will contact the patient and provide further information on rehabilitation.