Immediate weight-bearing protocol for the determination of ankle stability in patients with isolated distal fibular fractures

Eric K. Bonness, Justin C. Siebler, Lori K. Reed, Elizabeth R. Lyden, Matthew A. Mormino

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate an alternative protocol for allowing immediate weight-bearing (WB) as tolerated in a functional walking boot in patients with a medial clear space (MCS) of less than 4 mm on nonstressed initial radiographs with subsequent WB radiographs at 1-week follow-up to determine if this can differentiate stable from unstable distal fibular fractures. Design: Retrospective case series. Setting: Level 1 trauma center. Patients: Seventy-nine patients who sustained an isolated distal fibular fracture with an MCS less than 4 mm on initial non-weight-bearing radiographs during a 6-year period. Intervention: Patients with MCS less than 4 mm on 1-week radiographs were treated nonoperatively. Patients with MCS greater than or equal to 4 mm were treated operatively. Main Outcome Measurements: Medial clear space measurements on WB ankle radiographs at the time of radiographic bony union. Results: Two of the 79 (2.5%) patients had an MCS greater than 4 mm at 1-week follow-up with WB radiographs and underwent operative fixation. The remaining 77 patients were treated nonoperatively. All 77 patients had an MCS less than 4 mm on WB radiographs at the time of radiographic healing. Conclusion: These results suggest that our immediate weight-bearing protocol may be an effective method for determination of functional ankle stability only in the setting of an isolated distal fibula fracture with MCS less than 4 mm. However, it should be cautioned that careful evaluation of WB radiographs for joint asymmetry and/or MCS widening is mandatory to avoid poor outcomes.

Original languageEnglish (US)
Pages (from-to)534-537
Number of pages4
JournalJournal of Orthopaedic Trauma
Volume32
Issue number10
DOIs
StatePublished - Jan 1 2018

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Weight-Bearing
Ankle
Fibula
Trauma Centers
Walking
Joints

Keywords

  • Immediate weight-bearing boot
  • Isolated distal fibula fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Immediate weight-bearing protocol for the determination of ankle stability in patients with isolated distal fibular fractures. / Bonness, Eric K.; Siebler, Justin C.; Reed, Lori K.; Lyden, Elizabeth R.; Mormino, Matthew A.

In: Journal of Orthopaedic Trauma, Vol. 32, No. 10, 01.01.2018, p. 534-537.

Research output: Contribution to journalArticle

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AU - Mormino, Matthew A.

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N2 - Objective: To evaluate an alternative protocol for allowing immediate weight-bearing (WB) as tolerated in a functional walking boot in patients with a medial clear space (MCS) of less than 4 mm on nonstressed initial radiographs with subsequent WB radiographs at 1-week follow-up to determine if this can differentiate stable from unstable distal fibular fractures. Design: Retrospective case series. Setting: Level 1 trauma center. Patients: Seventy-nine patients who sustained an isolated distal fibular fracture with an MCS less than 4 mm on initial non-weight-bearing radiographs during a 6-year period. Intervention: Patients with MCS less than 4 mm on 1-week radiographs were treated nonoperatively. Patients with MCS greater than or equal to 4 mm were treated operatively. Main Outcome Measurements: Medial clear space measurements on WB ankle radiographs at the time of radiographic bony union. Results: Two of the 79 (2.5%) patients had an MCS greater than 4 mm at 1-week follow-up with WB radiographs and underwent operative fixation. The remaining 77 patients were treated nonoperatively. All 77 patients had an MCS less than 4 mm on WB radiographs at the time of radiographic healing. Conclusion: These results suggest that our immediate weight-bearing protocol may be an effective method for determination of functional ankle stability only in the setting of an isolated distal fibula fracture with MCS less than 4 mm. However, it should be cautioned that careful evaluation of WB radiographs for joint asymmetry and/or MCS widening is mandatory to avoid poor outcomes.

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