2025 AOFAS Annual Meeting-Resident Program: Fix vs. Fuse Debates

Video Transcription

Video Summary

This video is a comprehensive panel discussion on the challenges and decision-making processes involved in foot and ankle trauma and surgery, particularly focusing on when to fix fractures or opt for fusion. The speakers, all early-career physicians, share cases and perspectives on managing complex injuries like distal tibia fractures, pilon fractures, talus avascular necrosis, Lisfranc injuries, and midfoot trauma.<br /><br />Key points include the debate over fixing versus fusing acute ankle fractures, emphasizing individualized approaches rather than rigid protocols. Fixation is often favored due to fractures' innate healing potential, but fusion is appropriate in cases with severe joint destruction, neuropathy, or complicated comorbidities. The importance of joint preparation in fusion surgeries is highlighted, especially in trauma settings. Talus avascular necrosis scenarios illustrate newer treatments like total talus replacement, an emerging and promising option that aims to preserve joint motion and reduce complications compared to fusion.<br /><br />For midfoot injuries, primary arthrodesis (fusion) generally yields better outcomes and fewer secondary surgeries than open reduction and fixation, but exceptions exist, such as in highly active dancers where preserving joint motion is critical. The panel stresses the importance of shared decision-making tailored to patient needs.<br /><br />The discussion also addresses practical aspects for trainees and new surgeons: the variety in foot and ankle practice, learning new techniques especially minimally invasive surgery, mentorship opportunities, integrating into practice, and handling boards with evolving standards.<br /><br />Overall, the session underscores the complexity and nuance in foot and ankle trauma care, promoting personalized treatment and continual learning within a supportive community.

Asset Caption

Fix vs. Fuse Debates
Moderator: Amanda J. Fantry, MD

Distal Tibia and Ankle Fractures: ORIF vs. Arthrodesis
Megan L. Campbell, MD; Sara H. Galli, MD

Talus Avascular Necrosis and Failed Total Ankle
Arthroplasty: TTC Arthrodesis vs. Total Talus
Lara C. Atwater, MD; Samuel E. Ford, MD

Lisfranc/Midfoot Fracture Dislocation: ORIF vs. Arthrodesis
Matthew S. Conti, MD; Kenneth Smith Jr., MD

Keywords

foot and ankle trauma

ankle fracture fixation

fusion surgery

distal tibia fractures

pilon fractures

talus avascular necrosis

Lisfranc injuries

midfoot trauma

primary arthrodesis

joint preservation

total talus replacement

shared decision-making

minimally invasive surgery

mentorship in surgery

personalized treatment