Serial Radiographs Do Not Change the Clinical Course of Nonoperative Stable OTA/AO 44-B1 Ankle Fractures

Objective: To assess radiographic markers of ankle stability in stable OTA/AO 44-B1 ankle fractures. Design: Retrospective review. Setting: Academic Level-I trauma hospital. Patients: One hundred thirty-four patients with stable OTA/AO 44-B1 (Danis-Weber B, Supination-External Rotation-II) ankle fractures. Intervention: Analysis of mortise view radiographs at the time of initial evaluation and final follow-up. Variables measured: (1) medial clear space; (2) Mueller-Nose Distance. Main Outcome Measure: Change in radiographic measurements resulting in conversion to operative intervention. Results: Patients followed up an average of 2.6 visits in our clinics (SD 1.06). Patients received an average of 11.2 individual radiographic images to evaluate their injury (SD 3.9, maximum 29). No patients progressed to surgery in this cohort. Mean medial clear space at the time of injury was 3.4 mm (SD 0.8) and was 3.3 mm (SD 0.7) at the time of final follow-up (P = 0.1). Mean Mueller-Nose measurement at the time of injury was 3.5 mm (SD 1.0) and was 3.5 mm (SD 0.8) at the time of final follow-up (P = 0.47). Conclusions: No patients with stable OTA/AO 44-B1 fractures proceeded to surgery for loss of tibiotalar reduction or any other cause. Radiographic relationships were conserved during the follow-up, and serial radiographs may not be needed when managing these patients. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.