[Is functional conservative treatment of stable lateral ankle fractures justified?]

For Weber type B ankle fractures, operative treatment is generally recommended. Yet, there is no general agreement about the role of functional treatment. In a prospective follow-up study from December 1990 to May 1994, 146 patients were reviewed. The mean follow-up time was 17.3 months for clinical examinations and 19.6 months for X-rays. There were no failures. In all, 85 patients (58%) were treated conservatively (group K). A below-the-knee plaster was applied to 23 patients for 6 weeks, and 62 patients had functional treatment with an ankle brace. According to the Olerud Score, the first subgroup (K-plaster) achieved 89.4 points and the last (K-func.) reached 95.7 points. There were no signs of post-traumatic arthritis. 61 patients (42%) had open reduction and internal osteosynthesis (group OP). In 19 patients a plaster immobilization was necessary, and in 42 patients early mobilization was possible. The first subgroup (OP-plaster) achieved 85.0 points in the Olerud Score; the last (OP-func.) achieved 92.4 points. According to the degree of instability following ankle injuries, a new algorithm for treatment of type B ankle fractures is described, emphasizing early mobilization and functional after treatment.