Cast immobilization demonstrated non-inferiority to open reduction and internal fixation (ORIF) for Weber B fractures that are stable on static radiographs but unstable under stress testing.
At a two-year follow-up, Olerud-Molander Ankle Scores (OMAS) were comparable between the cast group (89) and the surgery group (87).
Surgical intervention was associated with a higher rate of secondary procedures, primarily for hardware removal, and a greater risk of wound-related infections.
The findings suggest that mechanical stability achieved via casting is sufficient for fractures with an initially congruent mortise, potentially shifting the standard of care away from routine surgery.
Introduction: The Dilemma of the Unstable Weber B Fracture
