{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:33:13Z","timestamp":1790443993520,"version":"4.1.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","license":[{"start":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T00:00:00Z","timestamp":1690502400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9,20]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Replacing gravity stress tests with weight-bearing radiographs to evaluate the stability of Weber B (also called Lauge-Hansen supination-external rotation [SER]) ankle fractures results in a lower surgery rate, thus avoiding associated risks and complications. Still, nonoperative treatment of weight-bearing stable fractures is controversial because of the scarcity of strong evidence. We investigated the influence of a concomitant unstable gravity stress test compared with a stable gravity stress test on outcomes after nonoperative treatment of weight-bearing stable fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a prospective, noninferiority study on 149 patients with Weber B ankle fractures and stable weight-bearing radiographs. Gravity stress radiographs classified fractures as stable (SER2 [n = 88]) or partially unstable (SER4a [n = 61]). All were treated with a functional orthosis and weight-bearing was allowed; patients were followed for 2 years. The primary outcome was the Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ), with a range from 0 to 100, in which lower scores indicate fewer symptoms. A noninferiority margin was prospectively defined as 7.5 points. The secondary outcomes included the Olerud-Molander Ankle Score, assessment of ankle congruence, and treatment-related adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The primary outcome data were available for 144 (96.6%) of 149 participants at 2 years. The between-group difference in the MOXFQ score was 1.0 point (95% confidence interval, \u22121.4 to 3.4 points; p = 0.397) in favor of the SER2 group, consistent with noninferiority. We found no appreciable between-group differences for any other outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In Weber B\/SER ankle fractures that are stable on weight-bearing radiographs, are treated with removable orthoses, and are allowed to bear weight, a concomitant unstable gravity stress test (SER4a) was not associated with worse patient-reported or radiographic outcomes compared with a stable gravity stress test (SER2) at the 2-year follow-up. Thus, the identification of stress instability seems redundant, which questions the applicability of stress instability for surgical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Diagnostic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.23.00195","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T14:35:00Z","timestamp":1690468500000},"page":"1435-1441","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":22,"title":["Concomitant Unstable and Stable Gravity Stress Tests on Weight-Bearing Stable Weber B Ankle Fractures Treated Nonoperatively"],"prefix":"10.2106","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9941-4518","authenticated-orcid":false,"given":"Martin G.","family":"Gregersen","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, \u00d8stfold Hospital Trust, Gr\u00e5lum, Norway"},{"name":"Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0275-2965","authenticated-orcid":false,"given":"Hilde Stendal","family":"Robinson","sequence":"additional","affiliation":[{"name":"Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1683-8214","authenticated-orcid":false,"given":"Marius","family":"Molund","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, \u00d8stfold Hospital Trust, Gr\u00e5lum, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,7,28]]},"reference":[{"issue":"Suppl 1","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Introduction: fracture and dislocation classification compendium-2018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.fas.2014.09.010","article-title":"The effect of different methods of stability assessment on fixation rate and complications in supination external rotation (SER) 2\/4 ankle fractures","volume":"21","author":"Dawe","year":"2015","journal-title":"Foot Ankle Surg."},{"issue":"9","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1177\/10711007211027286","article-title":"Weightbearing radiographs reliably predict normal ankle congruence in Weber B\/SER2 and 4a fractures: a prospective case-control study","volume":"42","author":"Gregersen","year":"2021","journal-title":"Foot Ankle Int."},{"issue":"7","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1177\/1071100717702589","article-title":"Weightbearing vs gravity stress radiographs for stability evaluation of supination-external rotation fractures of the ankle","volume":"38","author":"Seidel","year":"2017","journal-title":"Foot Ankle Int."},{"key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"k5432","DOI":"10.1136\/bmj.k5432","article-title":"Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial","volume":"364","author":"Kortekangas","year":"2019","journal-title":"BMJ."},{"issue":"7","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1302\/0301-620X.99B7.BJJ-2016-1087.R1","article-title":"When is a simple fracture of the lateral malleolus not so simple? 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