Retrospective cohort study of 57 patients with isolated lateral malleolar fractures asking whether weightbearing radiographs obtained 3–10 days post-injury can reliably identify stable SER-II injuries — and safely defer or avoid surgery — compared to manual and gravity stress testing.
When you see an isolated lateral malleolar fracture without obvious talar subluxation on initial films, don't rush to stress testing — have the patient return in 3–7 days for a weightbearing AP radiograph: if the medial clear space is <4 mm and not >1 mm wider than the superior clear space, treat non-operatively regardless of which external support device you choose.
This approach avoids the systematic overestimation of instability inherent to manual and gravity stress views and spares most patients an unnecessary operation.
Retrospective cohort study of 57 patients with isolated lateral malleolar fractures asking whether weightbearing radiographs obtained 3–10 days post-injury can reliably identify stable SER-II injuries — and safely defer or avoid surgery — compared to manual and gravity stress testing.
When you see an isolated lateral malleolar fracture without obvious talar subluxation on initial films, don't rush to stress testing — have the patient return in 3–7 days for a weightbearing AP radiograph: if the medial clear space is <4 mm and not >1 mm wider than the superior clear space, treat non-operatively regardless of which external support device you choose.
This approach avoids the systematic overestimation of instability inherent to manual and gravity stress views and spares most patients an unnecessary operation.