It is well known that unimalleolar Weber B ankle fractures with a congruent mortise on initial radiographs can often be treated successfully with cast immobilization. However, when these fractures are deemed unstable on external rotation stress testing despite mortise congruency, the need for surgical fixation remains uncertain, and clinical practice varies widely. This randomized trial aimed to determine whether cast immobilization is non-inferior to surgery for such stress-test–positive unimalleolar Weber B ankle fractures.
In this study, 126 patients with unimalleolar Weber B fractures showing a congruent mortise but instability on stress testing were randomized to either six weeks of cast immobilization or open reduction and internal fixation followed by six weeks of casting. At two years, ankle function assessed using the Olerud-Molander Ankle Score was similar between groups (89…
