Operative vs. Nonoperative Management of Isolated Weber B Ankle Fractures

Background and objective Ankle fractures (AFs) are common in orthopedic practice, with Weber B fractures representing a significant proportion. These fractures occur at the syndesmotic level of the fibula and can be treated either operatively or nonoperatively. However, the optimal management approach remains debated, particularly for isolated fractures without medial or syndesmotic involvement. This study aims to compare the operative and nonoperative management outcomes of isolated Weber B AFs in terms of functional recovery, complication rates, and patient satisfaction. Methodology This retrospective cohort study was conducted at the Department of Orthopedics, Hayatabad Medical Complex, Peshawar, from February 3, 2022, to March 2, 2023. A total of 115 patients with isolated Weber B AFs were included. Patients were categorized into operative (n = 65, 56.5%) and nonoperative (n = 50, 43.5%) groups. Outcomes assessed at six months included functional recovery using the Olerud-Molander Ankle Score (OMAS), complication rates (e.g., malunion, nonunion, and infection), and patient satisfaction levels. Statistical analyses were performed to compare outcomes between groups. Results The operative group demonstrated significantly higher OMASs (89.2 ± 6.3) than the nonoperative group (81.4 ± 8.1, P = 0.009). Malunion occurred in 4 patients (8%) in the nonoperative group but was not observed in the operative group (P = 0.034). Surgical site infections were observed in 3 patients (4.6%) in the operative group. Patient satisfaction was higher in the operative group, with 49 patients (75.3%) reporting being very satisfied compared to 32 patients (64%) in the nonoperative group (P = 0.045). Conclusions Operative management of isolated Weber B fractures offers better functional recovery and a lower risk of malunion compared to nonoperative treatment. For stable fractures, nonoperative management remains a valid option. Further long-term studies are required to assess the durability of outcomes for both approaches.