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Isolated Weber B ankle fracture with uncertain stability — MSRA MCQ

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HardAnkle and FootIsolated Weber B ankle fracture with uncertain stabilityMSRA

A 38-year-old woman attends an urgent treatment centre 2 hours after an inversion injury while stepping off a kerb. She cannot continue her shift because of ankle pain but has no other injuries. Radiographs show an isolated, minimally displaced Weber B fracture of the distal fibula. There is no talar shift, syndesmotic widening or medial clear-space widening. The ankle is swollen laterally, but there is also bruising and tenderness over the medial malleolus. The skin is intact and distal neurovascular examination is normal. What is the most appropriate management today?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Advise immediate unrestricted weight-bearing as tolerated and arrange orthopaedic follow-up within 2 weeks because fracture stability is uncertain

Explanation lettering: E = shown as A · A = shown as C · C = shown as E

This is a unimalleolar distal fibular fracture without radiographic talar shift or medial clear-space widening, so there is no demonstrated instability requiring immediate operative management. NICE advises immediate unrestricted weight-bearing as tolerated for non-surgically managed unimalleolar ankle fractures. However, medial bruising and tenderness raise concern for associated deltoid-ligament injury and therefore create uncertainty about stability despite the initially reassuring radiographs. This is the important exception: NICE advises orthopaedic follow-up within 2 weeks where stability is uncertain. She should also receive analgesia and clear advice to return if symptoms worsen; persistent symptoms at 6 weeks warrant review. B is overly restrictive and delays mobilisation without evidence of established instability. C would be appropriate for an unstable or displaced fracture, for example talar shift or a bimalleolar injury. D misses the required follow-up triggered by uncertain stability. E is not routinely indicated for an isolated minimally displaced unimalleolar fracture; planned follow-up is the recommended approach when stability is uncertain.

Reference: NICE NG38: Fractures (non-complex): assessment and management — Non-surgical orthopaedic management of unimalleolar ankle fractures (Published 2016; last reviewed 23 June 2025) — https://www.nice.org.uk/guidance/ng38/chapter/Recommendations