Weight-Bearing Test: A Straightforward and Reliable Indicator of Stability in Supination-External Rotation Type,...

Surgical indications of supination-external rotation type, Weber B (SER/Weber B) ankle fractures seem to be well defined according to the stability of the mortise. However, in some SER type lateral malleolar fractures with suspicious medial clear space widening, it is not easy to determine their stability. Clinical signs and other tests have been proposed to differentiate the stability of those fractures; however, these methods seem to have major concerns and limitations. Therefore, we adopted the weight-bearing (WB) test as a simple and predictable test and report the outcomes of the SER/Weber B type lateral malleolar fractures treated nonoperatively based on the WB test.

In patients with SER/Weber B lateral malleolar fractures without a definite sign of medial clear space widening, the WB test was performed to assess fracture stability. If the patients with SER type lateral malleolar fractures were able to stand and walk at least 4 steps without any walking aid, fractures were considered stable and nonoperative treatment was selected. Seventy-nine Weber B lateral malleolar fractures were managed nonoperatively. Among them, 68 patients were followed up for more than 6 months. Radiographic parameters, the visual analog scale (VAS) pain score, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were evaluated and analyzed.

Radiographic union was achieved in all 68 patients for whom the congruency of the joint was maintained through the last follow-up without any problems. The average VAS score was 1.03 (range, 0-5) and the mean AOFAS score was 87.34 (range, 58-100). All patients returned to their pre-injury level of daily activities.

Based on these good radiographic and clinical outcomes, the WB test appears to be a simple and reliable clinical indicator for identifying stable SER/Weber B type lateral malleolar fractures that can be managed nonoperatively.