Aims. Treatment of Weber B ankle fractures that are stable on weightbearing radiographs but unstable on concomitant stress tests (classified SER4a) is controversial. Recent studies indicate that these fractures should be treated nonoperatively, but no studies have compared alternative nonoperative options. This study aims to evaluate patient-reported outcomes and the safety of fracture treatment using functional orthosis versus cast immobilization. Methods. A total of 110 patients with Weber B/SER4a ankle fractures will be randomized (1:1 ratio) to receive six weeks of functional orthosis treatment or cast immobilization with a two-year follow-up. The primary outcome is patient-reported ankle function and symptoms measured by the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ); secondary outcomes include Olerud-Molander Ankle Score, radiological evaluation of ankle congruence in weightbearing and gravity stress tests, and rates of treatment-related adverse events. The Regional Committee for Medical and Health Research (approval number 277693) has granted ethical approval, and the study is funded by South-Eastern Norway Regional Health Authority (grant number 2023014). Discussion. Randomized controlled trials are needed to evaluate alternative nonoperative treatment options for Weber B/SER4a ankle fractures, as current clinical guidelines are based on biomechanical reasoning. The findings will be shared through publication in peer-reviewed journals and presentations at conferences. Cite this article: Bone Jt Open 2023;4(9):713–719

Abstract. Objectives. This study aims to evaluate the functional outcomes of early weight-bearing in a functional orthosis for conservatively managed, complete AT ruptures. Also we tried to evaluate the patient reported outcome with this form of treatment. Design. In this prospective study, we have analysed data from 41 patients with ultrasound diagnosed compete AT ruptures, with a gap of less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. Methods. Patients were followed up with foot and ankle trained physiotherapist for at least 1 year post-injury. At final follow up, the followings were measured: calf girth, single-leg heel raise height and repetitions. Furthermore, ATRS score and a patient feedback were taken on this final visit. Result. The mean ATRS score was 82.1, with a re-rupture rate of only 2% as compared to 5% in normal orthosis. The average calf bulk difference was 1.6 cm, the average heel raise height difference was 1.8cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p=0.02). However, there was no significant correlation between ATRS and heel raise height or heel raise repetitions. Conclusion. Early weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. A multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome

Fractures of the shaft of the humerus are usually easy to treat, irrespective of the personality of the fracture. The blood supply is abundant that union is rapid. There is no tendency to over-riding; on the contrary, the only danger is that the fragments may be allowed to distract by the weight of the limb and cause delayed union. The middle third is the most vulnerable in relation to delayed or non-union. This is because the main nutrient artery enters the bone very constantly at the junction of the middle and lower thirds or in the lower part of the middle third. The radial nerve is another structure at risk from fractures or operations on the humerus. It does not travel along the spiral groove of the humerus next to the bone as is commonly described; instead along most of its course it is separated from the humerus by a variable layer of muscle, and lies close to the inferior lip of the spiral groove. In general treatment of the fractured shaft of the humerus is not usually difficult. The fractured ends can be readily aligned with the patient sitting, when the weight of the forearm on the distal fragment will usually achieve an acceptable position. Support of the wrist a collar and cuff or narrow sling, allowing the elbow to lie free and unsupported may be all that is required. In the early stages when there is considerable pain a well padded plaster of Paris U-slab passing from the region of the acromion down to the olecranon and up the inner side of the arm to the axilla and bandaged in place is very effective in relieving discomfort. After two weeks the collar and cuff bandage can be replaced by a functional orthosis type Sarmiento for another four to six weeks. A “ hanging cast” popularized by Caldwell is no longer recommended because it may distract the fracture and produce delayed union