Management of Weber B Ankle Fractures: What have We Learnt since the CROSSBAT Trial?

Weber B fractures account for about 50% of all fractures at the ankle joint.Despite being a common injury, there is clinical equipoise in the management of an isolated lateral malleolar fracture with presumed medial ligamentous injury.The Combined Randomized and Observational Study of Surgery for type B Ankle fracture Treatment (CROSSBAT) study was a multicenter randomized control trial that also had an observational cohort arm.It showed that nonoperative management of Weber B fractures produced equivalent functional results at 1 year and avoided risks and complications that are associated with operative treatment.Other studies have shown similar results in short to mid-term follow-ups.The key to decision-making in ankle fracture is evaluating the stability of the ankle mortice.Weight-bearing radiographs are gaining popularity in this assessment as we understand the important role of the deep deltoid ligament.A lateral malleolar fracture with a medial ligamentous injury that is deemed to be stable by weight-bearing X-rays can be safely managed nonoperatively.Long-term studies are needed to calculate the relative risk of developing post-traumatic arthrosis in these patients compared to those who underwent fixation.