Goal of the course
The Advanced Principles of Foot and Ankle Trauma course covers the principles and current concepts in the treatment of more complex injuries and complications for doctors of podiatric medicine (DPMs), incorporating the latest techniques in operative fracture management.
Course description
Before attending the course, participants complete a self-assessment questionnaire and view a series of online, prerecorded presentations related to the 4 areas addressed during the course (available October 2024). The face-to-face course contains evidence-based lectures and small group discussions to further develop decision-making and management skills. During the practical exercises, participants will be trained in the application of fixation techniques for several specific fractures in the foot and ankle.
Target participants
DPMs in later stages of training and practicing DPMs interested in furthering their knowledge and skills in operative fracture management.
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American College of Foot and Ankle Surgeons is approved by the Council on Podiatric Medical Education as a provider of continuing education in podiatric medicine.
Jointly-Provided by:
This activity has been planned and implemented in accordance with the standards and requirements for approval of providers of continuing education in podiatric medicine through a joint provider agreement between The American College of Foot and Ankle Surgeons, Chicago, Illinois and AO North America, Devon, Pennsylvania.
CME Sign-In Policy
Registration and payment does not automatically result in issuance of CME credits. You must scan your badge each morning and afternoon to receive CME credits. Failure to scan your badge will result in a loss of CME credits. Upon email notification, certificates will be available online approximately 2 weeks post course.
While attendance verification certificate states that it is possible to earn CME hours and The American College of Foot and Ankle Surgeons has made a good faith effort to monitor attendance, the physician is ultimately obligated to honestly report what he/she has attended to all appropriate bodies, including their licensing boards.
Designation Statement -The American College of Foot and Ankle Surgeons has approved this activity for a maximum of [Hours Pending] continuing education contact hours..
Expected results of AONA's CME activities for surgeons, fellows, and residents are to:
• Increase their knowledge base and surgical skill level
• Improve competence by applying advances of knowledge in patient care in the areas of trauma, degenerative disorders, deformities, tumors, and reconstructive surgical techniques
• Address practice performance gaps by improving management of aspects of traumatic injuries and musculoskeletal disorders (i.e., pre-operative planning to post-operative care)
• Describe the physical examination and pathognomonic signs of the injury • Discuss use of stress radiography and advanced imaging to direct care including weight bearing comparative images, CT versus MRI and their limitations • Compare operative vs nonoperative management • Review indications controversies surrounding ORIF vs primary fusion.
• Describe incisional approaches • Recognize the importance of anatomic reduction relative to the risk of post traumatic arthritis • Understand stabilization techniques: Metal and flexible options • Compare primary fusion technique: Fixation options
• Review the combination of an acute navicular and cuboid fracture and other possible associated fractures • Discuss navicular fracture management – incision approaches • Compare Use of mini rail external fixation to regain length with immediate or delayed plating • Discuss cuboid fractures – incision placement • Compare distraction with immediate vs delayed plating and need for bone void management/grafting
• Recognize the need for two incisions to perform ORIF • Describe techniques for obtaining fracture reduction • Understand risk of varus malunion secondary to malreduction • Describe options for screw placement • Describe options for placement of a lateral plate • Describe postoperative management
• Describe the angiosomes in relation to incision placement for calcaneal fractures and associated risk of limb threatening wound complications • Describe the incision placement for the extensile lateral approach • Describe the incision placement for the sinus tarsi approach • Describe closure options for incisional approaches for calcaneal fractures • Recognize potential pitfalls of incisional approaches used for calcaneal fractures
• Describe the timing of surgical intervention for sinus tarsi or minimally invasive means versus lateral extensile • Identify key structural components of a joint depression calcaneal fracture integral for sequential ORIF • Describe the procedure(s) for reducing different components of a joint depression calcaneal fracture • Describe the process for providing temporary stabilization of a joint depression calcaneal fracture • Identify options for placement and insertion of internal fixation • Recognize the role for external fixation in open calcaneal and high risk fractures. • Describe the technique for reducing and fixating an extra-articular tongue fracture
• Describe the post operative management for a talar neck fracture • Explain when to begin range of motion and strengthening after a talar neck fracture • Describe the post operative management for an intra-articular calcaneal fracture including timing of weightbearing to minimize risk of collapse • Explain when to begin range of motion and strengthening after an intra-articular calcaneal fracture • Recognize potential complications associated with talar neck and calcaneal fractures
• Describe the relationship between the posterior malleolus and the syndesmosis • Describe the various fracture patterns associated with increased risk of syndesmosis disruption • Assess stability of the syndesmosis preoperatively and intraoperatively including Cotton and external stress rotation testing. • Describe fixation options for the syndesmosis and posterior malleolus • Describe the pros and cons for ORIF of the posterior malleolus and Syndesmosis through an anterior and posterior approach
• Identify high risk ankle fractures • Describe the relationship between immunocompromised patients and risks of complications • Describe ORIF options to mitigate risk
• Describe the normal anatomy of the ankle mortise • Describe causes of malunion • Identify and describe the management of a short fibula malunion • Identify and manage unrecognized syndesmotic instability or failed surgical stabilization of the syndesmosis
• Describe the components of a Delta frame construct • List the reasons why a Delta frame would be applied • Describe how a Delta frame is applied across the ankle and foot • Identify and manage short fibula malunion • Identify and manage failed or unrecognized syndesmosis instability
• Define an established nonunion • Describe types of nonunion • Outline the contribution of mechanical and biological factors to development of a nonunion • Discuss appropriate strategies and timing for intervention • Evaluate the role of bone graft and biological bone growth stimulation in the treatment of nonunion • Recognize additional factors that contribute to nonunion
• Define an established malunion • Recognize planes of deformity (articular, length, rotation, angulation, combined) • Compare clinical and radiographic assessment of malunion (X-ray, CT, scanogram) • Describe the types of osteotomies and arthrodesis for managing a malunion
• Describe patterns and etiologies of degenerative changes that occur in the post-traumatic ankle joint • Describe the advantages and disadvantages of non-operative (including prosthetic and injection management) options • List indications and contraindications of open vs. arthroscopic ankle arthrodesis vs. total ankle replacement • Describe the advantages and disadvantages of different fixation options for arthrodesis and different implant options for total ankle implant arthroplasty
It is the policy of AO North America to abide by the Accreditation Council for Continuing Medical Education Standards for Commercial Support. Standard 2: “Disclosures Relevant to Potential Commercial Bias and Relevant Financial Relationships of Those with Control over CME Content,” requires all planners, including course directors, chairs, and faculty, involved in the development of CME content to disclose their relevant financial relationships prior to participating in the activity. Relevant financial relationships will be disclosed to the activity audience. The intent of the disclosure is not to prevent a faculty with a relevant financial or other relationship from teaching, but to provide participants with information that might be of importance to their evaluation of content. All potential conflicts of interest have been resolved prior to the commencement of this activity.
Some medical devices used for teaching purposes and/or discussed in AO North America’s educational activities may have been cleared by the FDA for specific uses only or may not yet be approved for any purpose. Faculty may discuss off-label, investigational, or experimental uses of products/devices in CME certified educational activities. Faculty have been advised that all recommendations involving clinical medicine in this CME activity are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.
All scientific research referred to, reported or used in this CME activity in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection and analysis.
AONA does not endorse nor promote the use of any product/device of commercial entities. Equipment used in this course is for teaching purposes only with the intent to enhance the learning experience.
The opinions or views expressed in this live continuing medical education activity are those of the faculty and do not necessarily reflect the opinions or recommendations of AO North America or any commercial supporter. The certificate provided pertains only to the participants’ completion of the course.
In-Kind Support
AO North America gratefully acknowledges in-kind support for equipment and technical staff from J&JMedTech.
Educational Grant
AO North America gratefully acknowledges funding for its education activities from the AO Foundation. The AO Foundation receives funding for education from Synthes GmbH.