There are two parts involved in the treatment of a stable lateral malleolus fracture. Clin Orthop Relat Res 1985;199:2838. b. Type B - Fractures at level of tibial plafond and typically extend proximally in a spiral or short oblique fashion. c. Type C - Fractures above the tibial plafond and associated with syndesmotic . Please enable it to take advantage of the complete set of features! To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. This normally takes approximately 6 weeks to unite (heal) although pain and swelling can be ongoing for 3 to 6 months. The Danis-Weber classification system uses the position of the level of the fibular fracture in its relationship to its height at the ankle joint. This study primarily aimed to summarize the current evidence on functional outc Once the ankle has been rehabilitated, RTP is usually approved after 10 to 12 weeks. For the Clinician: The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation for the patients who undergo surgery for an ankle fracture. Injury. Hold the position for at least 15 to 30 seconds. Protocol must be altered based on fixation strength at surgery and surgeon preference. For undisplaced distal tibial physeal fractures, follow-up in fracture clinic should occur within 7 days with a repeat x-ray. The predefined non-inferiority margin is set at 8 OMAS points. Disclaimer, National Library of Medicine Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected. An ongoing randomized, parallel group, non-inferiority trial comparing surgery and non-operative treatment for unstable Weber B-type ankle fractures with allocation ratio 1:1. If concern of wound, please take a picture and call Dr. Vora's office. endstream endobj startxref After providing informed consent, 126 patients aged 16 years or older with an unimalleolar Weber B-type unstable fibula fracture were randomly assigned to surgery (open reduction and internal fixation) or non-operative treatment (6-week cast immobilization). No commercial re-use. 60% of ankle fractures involve only the lateral malleolus.1 Fractures of the lateral malleolus proximal to the joint line correspond to syndesmotic injuries. This may persist for several months. Repeat 2 to 4 times a session, up to 5 sessions a day. c. Type C - Fractures above the tibial plafond and associated with syndesmotic . Virtual Fracture Clinic Weber A Ankle Fracture Patient Information Portsmouth Hospitals Fracture Clinic NHS Trust VIRTUAL Specialist Support This leaflet can be made available in another language, large print or another format. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. Background: Elastic stable intramedullary nailing (ESIN) is the gold standard for non-overweight children aged 6-12 years. Weber A - a fibular fracture below the level of the syndesmosis. For example, an isolated fracture, such as a fracture in the shaft of the fibula bone is uncomplicated and complete healing is high. Detailed recovery / rehabilitation protocol: Phase I: Weeks 1-3 Goals Safe non weight bearing crutches /knee-walker Incision care-keep clean and dry. The mechanical stimulus of the joint moving allows for improved joint surface remodeling/healing. b. Ankle Fracture - Weber B You have sustained a fracture to your fibula (outside ankle bone). A fluoroscopy scan is first obtained to ensure correct positioning (C). This reinforces the importance by talking about driving issues with patients, future higher level with evidence studies are needed to different varieties and grades of severity of ankle fractures. Percutaneous skeletal fixation. Keys to a Successful Outcome. $Z\`qH:X&$c`bd`T UQX k However, the complication rate using elastic stable intramedullary nailing is considerably high. Treatment of an ankle fracture 10.2106/00004623-199501000-00020 The commonly used Weber classification relies solely on the level of the lateral malleolar fracture relative to the ankle joint line.3 The mechanism of injury generally involves a twisting or This is not intended to substitute clinical decision making regarding the patient's proper progression based on evaluation findings. It has a role in determining treatment. 4% (103/2332) L 2 Conquest Hospital Restoration of normal gait mechanics. Secondary outcomes include the Foot and Ankle Score, a 100 mm Visual Analogue Scale for function and pain, the RAND-36-Item Health Survey for health-related quality-of-life, the range-of-motion of the injured ankle, malunion (ankle joint incongruity) and fracture union. Please speak to the Ward Manager who can advise you. The Dorsal Antiglide Plate in the Treatment of Danis-Weber Type-B Fractures of the Distal Fibula. This normally takes approximately 6 weeks to unite (heal) although pain and swelling can be ongoing for 3 to 6 months. a. doi: 10.1002/14651858.CD010836.pub2. ROM should be performed with the arm adducted close to the body. If the Orthopaedic Consultant considers this unstable, an operation with plate and screws may be required. endstream endobj 402 0 obj <. Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. Weber classification for lateral malleolar (fibula) fractures. An ongoing randomized, parallel group, non-inferiority trial comparing surgery and non-operative treatment for unstable Weber B-type ankle fractures with allocation ratio 1:1. Isometric strengthening exercises for the elbow and wrist. Shower boot or saran wrap with showers until closed. Hold one end of the towel in each hand, with your hands above your knees. Kings Drive, Eastbourne, East Sussex, BN21 2UD Interventions for treating ankle fractures in children. orthopedic devices; outcome assessment (health care); outcomes research; patient outcome assessment. Goal is 15 to 105 of motion by 14 days. A lateral malleolus fracture is relatively common among the elderly, but can also occur in the younger patient. To obtain an approximation of the true mortise, A standard, padded below the knee synthetic cast made by a trained plaster, MeSH Indicated for non-op treatment or ORIF. The Ridge, St Leonards-on-Sea, East Sussex, TN37 7RD Cast is applied from the tuberosity of the tibia to the base of the toes and is lined and padded. Continue elbow active and active assisted flexion exercises. New York Dynamic Neuromuscular Rehabilitation & Physical Therapy Best Physical Therapy and Therapist in NYC. Depending on the trauma and the accompanying soft-tissue injury, these fractures are either stable or unstable. Treatment-related complications and harms; symptomatic non-unions, loss of congruity of the ankle joint, reoperations and wound infections will also be recorded. When he came to our clinic, the muscle was not healing, and the patients muscle tissue had already begun to atrophy. Epub 2013 Jan 4. Dr Kevin Roth, Shoulder, Knee & Hip Surgeon, Palo Alto, CA Patient Resources Rehab/PT Protocols ORIF Ankle Fracture Rehabilitation Protocol Download PDF Version. Maintain shoulder, wrist, hand strength and ROM. PMC Aktuelle Probleme in Der Chirurgie. Type B - Fractures at level of tibial plafond and typically extend proximally in a spiral or short oblique fashion. immediately aware of signi cant pain and is unable to weight . It answers and provides substantive evidence for aggressive worry-free treatment for patients with stable unimalleolar Weber B ankle fractures. Cochrane Database Syst Rev. static views. These fractures may be referred to as a Weber fracture and are classified as A, B or C dependent on the site Elbow active and active-assisted flexion. 0300 131 4500, Bexhill Hospital Clipboard, Search History, and several other advanced features are temporarily unavailable. Ankle fractures involving the fibula proximal to the distal tibiofibular syndesmosis. If the Orthopaedic Consultant considers this unstable, an operation with plate and screws may be required. Progressively increase isotonic strengthening in flexion. Call for an appointment (03) 6231 2477, Hip Replacement for Residual Hip Dysplasia, Long Head of Biceps Pathology (at shoulder), Shoulder Arthritis and Total Shoulder Replacement, Rotator Cuff Repair, including Subscapularis, Rehab, Shoulder Instability Bankart Repair Rehab. This page will discuss ankle and foot fractures and the role that physiotherapists play in the rehabilitation of such injuries. 2016 Apr 1;4(4):CD010836. Sometimes a Plaster is used. It is recommended that clinicians collaborate closely with the referring physician regarding the timeframes for progression. A fracture is the same as a break. How Fractures Are Treated Weber/AO - categorizes fractures on level of the fibular fracture. The boot you have been given is for your comfort only and is not needed to aid fracture healing, but should be worn at all times when walking. Please see the picture below to understand where this injury is. The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature. D:@6 l/6@Ui V If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please phone the Fracture Care Team for advice. For displaced distal tibia physeal fractures managed with closed reduction and immobilisation should be reviewed in fracture clinic within 5 days. Die Verletzungen des oberen Sprunggelenkes. However, the primary concern related to non-operative treatment is increased risks of ankle mortise incongruency, leading to secondary surgery, early post-traumatic osteoarthritis and poor function. Weber A Ankle Fracture 19 4504.indd 1 30/07/2019 16:09:50 Passive extension. . Please refer to the following protocol to guide your rehabilitation after your tibial plateau fracture. Early passive joint motion is key. Careers. Return to Sport after a Soccer Ankle Injury: How soon is too soon? The cast is applied with the ankle joint placed at 90 angle (neutral dorsiflexion). Return to driving for ankle fractures treated without surgery is usually around 6-8 weeks after the injury. A fracture is an interruption of the continuity of bone. Patients with less complex fractures may progress Patella Fracture Rehab Protocol | Ortho.Boston team@ortho.boston Patella Fracture Rehab Protocol Keys to a Successful Outcome ROM exercises should not be forceful or too painful The brace should be locked in extension until 6 weeks while weight bearing * ** *** Protocol must be altered based on fixation strength at surgery and surgeon preference. Weber A fracture <10%. and a faulty diagnosis can make treatment a total waste of time. We hypothesize that non-operative treatment yields non-inferior functional outcome to surgery, the current standard treatment, with no increased risk of harms. The goal of this protocol is to provide a clinical guideline for the non-surgical and post-surgical course of physical therapy for a patient who has suffered an ankle fracture. . To obtain an approximation of the true mortise view, the leg is stabilized in an approximately 1015 of internal rotation, with the ankle in neutral dorsiflexion (A). Current clinical practice guidelines recommend surgical treatment for unstable Weber B-type fibula fractures. ANKLE FRACTURE PROTOCOL: NONOPERATIVE TREATMENT. the fracture is healed, Weber/AO - categorizes fractures. Roughly two-thirds of ankle fractures are unimalleolar injuries, the Weber B-type fibula fracture being by far the most common type. Acta Orthop Scand 1998;69:437. Begin active and active assisted supination and pronation. IV opioids should be used with caution in elderly patients, and non-steroidal anti-inflammatory drugs should be avoided (NICE 2016a). document.getElementById( "ak_js_3" ).setAttribute( "value", ( new Date() ).getTime() ); Physical therapy and rehab can be time consuming. back painless locomotion. Bilateral progressing to unilateral squat, step and matrix progression. van Leeuwen CAT, Hoffman RPC, Hoogendoorn JM. Take pain killers as prescribed. Elevation: Lie down and keep your ankle elevated above . Foot Ankle Int 2011;32:1417. Over the last 15 years in practice, I have progressed in my treatment of stable unimalleolar Weber B ankle fractures from 6 weeks of non-weight-bearing with a cast to a protocol of 3 weeks of. The influence of a diastasis screw on the outcome of Weber type-C ankle fractures. 781-429-7700 team@ortho.boston. Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures--an increasing problem? You may walk on the foot as comfort allows although you will find it easier to walk with crutches in the early stages. -. government site. Strong emphasis on restoring full dorsiflexion. 0 The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Stability criteria for nonoperative ankle fracture management. Ankle Fracture Rehab Protocol. Citation, DOI & article data. a. Begin active extension and extension strengthening once bony union is evident on xrays / indicated by Dr Watson. 2016 Oct;20(75):1-158. doi: 10.3310/hta20750. It is not intended to be a substitute for clinical decision making regarding the progression of a patient's This is important as the option to treat these fractures with a shorter duration of immobilization and with less rigid immobilization significantly improves patient compliance. At times the talus may completely pop out of the ankle joint associated with the fracture, in which case we call this a fracture dislocation. 10.3109/17453679809002355 Weber B-type fibular fracture with reduced ankle mortise. Depending on the trauma and the accompanying soft-tissue injury, these fractures are either stable or unstable. We have completed the patient enrolment and are currently in the final stages of the 2-year follow-up. From a diagnostic perspective, this interaction is invaluable. A standard, padded below the knee synthetic cast made by a trained plaster technician. Place a towel around your affected foot just under the toes. Unable to load your collection due to an error, Unable to load your delegates due to an error. Depending on wether the fracture is a Weber type A, B, or C depends exactly where the fracture is on the lower part of the fibula. These fractures are often managed operatively, although a small population of patients are still selected for nonoperative management. The .gov means its official. 2% (44/2332) 5. Kortekangas T, Haapasalo H, Flinkkil T, Ohtonen P, Nortunen S, Laine HJ, Jrvinen TL, Pakarinen H. BMJ. External rotation (ER) stress test. A Weber fracture occurs at the bottom of the fibula which is the bone on the outside of your shin. If your injury is classified as a stable Weber B type fracture, you will be treated in a boot. Incidence and clinical relevance of tibiofibular synostosis in fractures of the ankle which have been treated surgically Roll-A-Bout An alternative to crutches and wheelchairs. Mechanism is external rotation of the foot. Weber BG. Detailed recovery / rehabilitation protocol: Phase I: Weeks 1-3 Goals Safe non weight bearing crutches /knee-walker Incision care-keep clean and dry. Foot intrinsic strengthening. Rush rods versus plate osteosyntheses for unstable ankle fractures in the elderly. Type B: Fracture starts distally at level of ankle joint (syndesmosis) and extends proximally. Biofeedback Motor Control Training and Analysis, Sonoelastography for Rehabilitation, Enhanced Performance and Injury Prevention, Post-Exercise Recovery for Sports, Dance and Fitness, The Most Comprehensive Assessment for Strength and Power is Driven by Technology, Most ankle fractures take approximately six to eight weeks to heal, After surgery, patients can usually return to full weight-bearing activities after six to eight weeks, Once the ankle has been rehabilitated, RTP is usually approved after 10 to 12 weeks, The athletes training status, both prior to and post injury, The skill, experience and expertise of the physical therapist, The athletes compliance with the rehab protocol, The level of sport (recreational, competitive, professional). Keywords: ORIF Ankle Fracture Rehabilitation Protocol. Our location: NYC Midtown Manhattan, 130 W 42nd St. Suite 1055, Diagnostic Musculoskeletal Ultrasonography, Computer Assisted Rehabilitation Environment, Computer Assisted Rehabilitation Environment (C.A.R.E.N), Extracorporeal Magnetic Transduction Therapy, Postural Reeducation and posture treatment, KINEO intelligent load and reactive neuromuscular training. Please see the picture below to understand where this injury is. sooner. However, fracture at the knee and ankle takes longer time to heal and restriction and immobilization are paramount. official website and that any information you provide is encrypted . 2013 Mar;37(3):489-94. doi: 10.1007/s00264-012-1753-9. An ongoing randomized, parallel group . After surgery, patients can usually return to full weight-bearing activities after six to eight weeks. " jjt"{dXLI'cV) fM The broken bone often occurs in just the fibula (the thinner bone on the outside of your lower leg). Weber Fracture Anatomy. 10.3113/FAI.2011.0141 Passive extension. NWB on the operative extremity; Splint/Brace. Begin light isotonic strengthening of flexion. Type A - Fractures below the tibial plafond and typically transverse. Bethesda, MD 20894, Web Policies Calf stretch (knee bent) -. Specific changes in the program will be made by the physician as appropriate for the individual patient. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well. See this image and copyright information in PMC. The fracture is considered to be unstable when the medial clear space, measured between the lateral border of the medial malleolus and the medial border of the talus at the level of the talar dome, is 5 mm (D). This will depend on how the healing is progressing and how much discomfort you are having o Swelling It is very common to have swelling intermittently after ankle fractures. Bookshelf These may involve only the medial malleolus, the fibula, or both bones (which is called a bi-malleolar fracture). Ice application: Apply ice to help reduce pain and swelling. Danis-Weber classification of ankle fractures (Types A, Ankle fractures that require an ORIF include: The Danis-Weber classification (often known just as the Weber classification) is a. Long-term outcome in operatively and non-operatively treated isolated type B fibula fractures. Type A: fracture below the ankle joint Type B: fracture at the level of the joint, with the tibiofibular ligaments usually intact. For tillaux and triplane fractures < 2mm displacement, these can be . Edema control / swelling control Maximize ankle and hindfoot motion Full pronation and supination should be achieved by the end of the 8thweek. Weber C - a fracture above the level of the syndesmosis. Weber B - a fracture at or near the level of the syndesmosis. This is not intended to substitute clinical decision making regarding the patient's proper progression based on evaluation findings . Federal government websites often end in .gov or .mil. This condition is known as a lateral malleolus fracture. %PDF-1.6 % The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis. Fractures about the ankle. Goal: Regain full pain-free ROM of elbow and prevent shoulder and wrist stiffness. Holliers Hill, Bexhill-on-Sea, East Sussex, TN40 2DZ J Bone Joint Surg Am 1995;77:14252. and transmitted securely. Phase I (0 to 7 days) Nevertheless, the question arises of whether the indication for elastic stable intramedullary nailing therapy can be extended and which factors must be taken into account . Full flexion and extension ROM should be achieved by the end of 6 weeks. Schepers T, De Vries MR, Van Lieshout EM, Van der Elst M. Int Orthop. The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years. Isometric and early isotonic ankle. Current clinical practice guidelines recommend surgical treatment for unstable Weber B-type fibula fractures. The rationale for non-inferiority design is as follows: By being able to prove non-inferiority of non-operative treatment, we would be able to avoid complications related . Weber C fracture patterns (>80%) fixation usually not required when fibula fracture within 4.5 cm of plafond. Dynamic ultrasonography examination demonstrating the full thickness tear and already occurring muscle atrophy due to misdiagnosis and not referring the patient to proper diagnostic workup, Demonstration of how very small muscle defect is made and revealed to be a complete tear with muscle contraction under diagnostic sonography (not possible with MRI), Complete tear of rectus femoris with large hematoma (blood), Separation of muscle ends due to tear elicited on dynamic sonography examination. These ankle fracture stretches and exercises should only be done after your broken ankle has healed, and you are cleared by your doctor to start physical the. Plaster to immobilise elbow until wound review. Weber B fractures ~40-50%. 442 0 obj <>stream An official website of the United States government. Roughly two-thirds of ankle fractures are unimalleolar injuries, the Weber B-type fibula fracture being by far the most common type. Looking for a Prolotherapy Specialist in NYC? This site needs JavaScript to work properly. The goal of this protocol is to provide a clinical guideline for the non-surgical and post-surgical course of physical therapy for a patient who has suffered an ankle fracture . 4010 West 65th Street, Edina, MN 55435 Phone: 952-944-2519 Fax: 952-944-0460 www.mosmi.org Ankle Fracture Post-op Rehabilitation Protocol sharing sensitive information, make sure youre on a federal -, Pakarinen HJ, Flinkkil TE, Ohtonen PP, et al. You have sustained a fracture to your fibula (outside ankle bone). Type C: Fracture proximal to syndesmosis (level of ankle joint) Download figure Open in new tab Download powerpoint Randomisation and blinding The break may be below, at the same level or above your ankle joint. Pull back gently with the towel so that your foot stretches toward you. Tibial Plateau Fracture Rehab Protocol. Dr. Weber is an Orthopaedic Surgeon & Sports Medicine Specialist Home / Patient Info / Rehabilitation Protocol Rehabilitation Protocol HIP Arthroscopic Gluteus Medius Repair Labral Repair With or Without FAI Component Proximal Hamstring Repair Rehabilitation Protocol Rehab Protocol for Open Gluteus Medius Repair KNEE ACI OF FEMORAL CONDYLE A pilon fracture typically occurs as the result of a high-energy event, such as a car collision or . FOIA Then, you can gradually progress to putting weight on the ankle again. What is an ankle fracture? See rights and permissions. Weber C ankle fractures are unstable ankle fractures occurring above the syndesmosis. Author(s) (or their employer(s)) 2021. Oral paracetamol should be offered for mild pain, oral paracetamol and codeine for moderate pain and intravenous (IV) paracetamol with IV morphine titrated to effect for severe pain (NICE 2016a). Mechanism is supination of the foot. The location of the fracture dictates restrictions placed on patients, and immobilization. Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial. External rotation (ER) stress test. If your injury is classified as a stable Weber B type fracture, you will be treated in a boot. hbbd```b``N+, In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. Verlag Hans HuberVienna 1972. Physical therapy and management of symptoms. At the time of fracture, the patient is. -, Michelson JD. HHS Vulnerability Disclosure, Help Type A - Fractures below the tibial plafond and typically transverse. The rationale for non-inferiority design is as follows: By being able to prove non-inferiority of non-operative treatment, we would be able to avoid complications related to surgery. The bone is over known as the lateral malleolus of the ankle. 2019 Dec;50(12):2318-2323. doi: 10.1016/j.injury.2019.10.006. You have sustained a fracture to your fibula (outside ankle bone) this is classified as a stable Weber A type fracture. Rest and Elevation: Try to rest the leg for the first 24-72 hours to allow the early stage of healing to begin. This site and all materials are property of L.K chiropractic P.C.. Therefore, the most imp ortant aim of rehabilitation is to r st get. Your health is our priority.Review our guidelines for patient health and safety. Sometimes a Plaster is used. A 30 mm calibration disk is used to calibrate the radiographs (A), with measurements made to an accuracy of 1 mm. 2019 Jan 23;364:k5432. The primary, non-inferiority outcome is the Olerud-Molander Ankle Score (OMAS) at 2 years (primary time point). Many different factors influence the post-operative ankle ORIF rehabilitation outcomes, including rate of healing, complexity of the fracture and/or need for hardware removal. The problem with a timeline approach is that every injury has unique characteristics, and . Weber/AO - categorizes fractures on level of the fibular fracture. 8600 Rockville Pike A pilon fracture is a type of break that occurs at the bottom of the tibia (shinbone) and involves the weight-bearing surface of the ankle joint. Olecranon Fracture Rehab Protocol. Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. Cold packs: A cold pack (ice pack or frozen peas wrapped in a damp towel) can provide short term pain relief. Epub 2019 Oct 4. The swelling is often worse at the end of the day and elevating it will help. Missed posterior deep, Li YY, et al. Shower boot or saran wrap with showers until closed. %%EOF Apply this to the sore area for up to 15 minutes, every few hours ensuring the ice is never in direct contact with the skin. 0300 131 4500. First, you need to focus on resting and getting the swelling to go down. May be associated with medial ankle injury/fracture or posterior malleolus fractures. 427 0 obj <>/Filter/FlateDecode/ID[<5EA50E583687AE49B0187214D2FDEEC9>]/Index[401 42]/Info 400 0 R/Length 119/Prev 453081/Root 402 0 R/Size 443/Type/XRef/W[1 3 1]>>stream 0300 131 4500, Eastbourne District General Hospital A follow-up study of 306/321 consecutive cases. Published by BMJ. Ankle Fracture Rehab Protocol. Fractures of the ankle joint are common amongst adults. Weber C fractures are above the ankle joint and are associated with a syndesmotic injury. Keene DJ, Mistry D, Nam J, Tutton E, Handley R, Morgan L, Roberts E, Gray B, Briggs A, Lall R, Chesser TJ, Pallister I, Lamb SE, Willett K. Health Technol Assess. Accessibility Evaluation. Type A: Fracture below level of ankle joint. This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Would you like email updates of new search results? The https:// ensures that you are connecting to the The site is secure. Lindsj U. Operative treatment of ankle fracture-dislocations. Most ankle fractures take approximately six to eight weeks to heal. doi: 10.1136/bmj.k5432. 401 0 obj <> endobj Often a fracture of the lateral malleolus occurs in combination with a sprained ankle or other fractures of the foot, ankle or lower leg (such as following trauma). Before Full active and passive ROM all planes. hb```e`` "/33 0PcC)J9As=gNNq*}e99kVv:p'AT7[%}nxq*ALB`2LwtEADm[# bH(CT2(w0y_+%JxE3X. The weber b fracture rehabilitation protocol that you will need surgery, sensitivity will not uncommon setting up with your physical therapy protocols. PHASE I: 0-2 weeks: Weight Bearing. Re-use permitted under CC BY-NC. Fractures of the Ankle and the Distal Part of the Tibia. The Weber classification is simple, reliable, and reproducible, and thus it has been utilized routinely by emergency physicians.1,2 Injuries to the distal fibula, below the talar dome, are classified as type A and are stable fractures. An ER force of approximately 8 10 lb/3.64.5 kg is then applied to the forefoot before repeating the scan (B, D). 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