Nonoperative Treatment of Bimalleolar Equivalent Ankle Fractures: A Retrospective Review of 51 Patients

The purpose of this retrospective study was to determine the outcome of bimalleolar equivalent ankle fractures in patients who were treated nonoperatively. The charts of 214 patients with isolated Weber B (supination-external rotation pattern) fibula fractures were reviewed. Fifty-one patients met the inclusion criteria and were administered the American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey by telephone or personal interview. The average medial clear space was 5.09 mm; the average American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey score was 84.22. A medial clear space of 4, 5, 6, and 7 mm resulted in American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores of 90.22, 89.4, 72.0 and 63.17, respectively. Further analysis showed significant differences in American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores between the 4 mm medial clear space group and the 6 mm and 7 mm medial clear space groups; the 5 mm medial clear space group and the 6 mm and 7 mm groups. Our results suggest that medial tenderness and ecchymosis alone are not sufficient to meet operative criteria, a higher medial clear space on stress gravity views correlates with a lower American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey score, and that there are significant differences in American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores between groups with medial clear space 4 to 7 mm. ACFAS Level of Clinical Evidence: 2b.