Steven M Hadley, John J Peabody, Rachel Bergman, Sarah J Westvold, Eric H Durudogan, Frederic Washburn, Shaun Chang, Muhammad Y Mutawakkil, Milap Patel, Anish R Kadakia
Patients with anatomically reduced ankles may achieve population mean PROMIS regardless of Weber subtype. Although at early follow-up Weber C fractures have higher radiographic complication rates, including early-onset DJD, proper reduction and stabilization may be especially important to help patients achieve equivalent functional outcomes to patients with Weber B fractures. Higher BMI, female sex, and older age may negatively affect outcomes.
BACKGROUND: It remains unclear whether Weber subtype correlates with outcomes measured by validated Patient Reported Outcomes Measurement Information System (PROMIS) following ankle fracture surgery. We examine whether Weber subtype correlates with PROMIS.
METHODS: This was a retrospective review of 527 patients who underwent ankle fracture surgery at a single institution (2016-2021). Two fellowship-trained orthopaedic surgeons independently reviewed all radiographs. Of the 527 who were included in final analysis evaluating complications, 182 with Weber B and Weber C fractures completed PROMIS physical function (PF) and pain interference (PI) measures. All 182 had anatomically reduced ankles and were included for analysis of PROMIS. Primary outcome was PROMIS.
RESULTS: Among survey responders (n = 182), no significant difference existed between Weber B and Weber C anatomically reduced in mean PF (52.3 ± 9.9 vs 53.5 ± 9.2, P = .47) and PI (48.4 ± 8.8 vs 47.0 ± 7.7, P = .34). In adjusted-regression, Weber B and Weber C were not significantly different for mean PF (53.8 vs 53.9, P = .92) or PI (48.0 vs 46.4, P = .27). Body mass indexes (BMIs) of 30 or greater had worse mean PF (P = .04) and PI (P < .01). Compared with males, females had worse mean PF (P < .001) and PI (P < .01). Older patients had lower PF compared to younger (P = .01). In overall cohort (n = 527), Weber C radiographic complication rate was 32.3% (41/127) vs 11.5% (46/400) Weber B (P < .001), with higher syndesmotic loss of reduction and early-onset degenerative joint disease (DJD) rates (9.4% vs 1%, P < .001; 11.8% vs 2.5%, P < .001, respectively). Weber C was 3.52 times (95% CI: 2.08-5.98) as likely to have radiographic complication as Weber B.
CONCLUSION: Patients with anatomically reduced ankles may achieve population mean PROMIS regardless of Weber subtype. Although at early follow-up Weber C fractures have higher radiographic complication rates, including early-onset DJD, proper reduction and stabilization may be especially important to help patients achieve equivalent functional outcomes to patients with Weber B fractures. Higher BMI, female sex, and older age may negatively affect outcomes.
LEVEL OF EVIDENCE: Level III, retrospective comparative study.