Moderator: John Y. Kwon, MD
Faculty: Anish R. Kadakia, MD, Samuel B. Adams Jr., MD, and Carroll P. Jones, MD

Description

There is sparse data to guide surgeons and patients alike regarding the use of VTE prophlyaxis after foot and ankle surgery. Existing studies are generally either retrospective or underpowered, and study recommendations range from those that suggest the rate is low and therefore no prophylaxis is necessary post-operatively, to those that suggest routine VTE prophylaxis is necessary even when treating patients nonoperatively with cast immobilization. Furthermore, the use of VTE prophylaxis is not entirely benign, with complications ranging from bleeding events and potentially heightened wound complication rates to rare but life-threatening immunogenic responses to chemoprophylaxis. This leaves patients and surgeons alike with little ability to navigate the risk-benefit analysis inherent to any surgical decision-making. When superimposed on a regulatory environment in which VTE has become a “never event”, foot and ankle surgeons would benefit from a review of the existing data as well as assistance identifying where gaps in the literature exist. 

Target Audience

This course is designed for the experienced foot and ankle surgeon, the generalist orthopaedic surgeon interested in expanding their scope of practice into foot and ankle, post-residency fellows and residents who treat acute and chronic problems of the foot and ankle, and allied health professionals who work in foot and ankle care.

Agenda
Moderator’s Introduction and Format Review
John Kwon, MD

Syndesmosis and the Deltoid Ligament
Anish Kadakia, MD

Posterior Malleolus Fractures
Samuel Adams, MD

Fibular Malunion
Carroll Jones, MD

Case Discussion
Discussion

Course Objectives
Upon completion of this course, learners should be able to:

1. Identify which specific patient and injury characteristics make operative management of ankle fractures more difficult.
2. Discuss the role and indications for adjunctive procedures such as ankle arthroscopy, syndesmotic reduction and fixation and deltoid ligament repair.
3. Apply technical considerations when performing revision ankle open reduction internal fixation for the nonunited or malunited ankle.

AOFAS is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AOFAS designates this enduring material for a maximum of up to 1.0 AMA PRA Category 1 Credits™.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Accreditation
The American Orthopaedic Foot & Ankle Society (AOFAS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians.

Credit Designation Statement
The AOFAS designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME requirements of the American Board of Orthopaedic Surgery’s Maintenance of Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABOS credit.

CME Certificates
Participants are required to listen to the podcast, answer the evaluation and claim CME at the end of the webinar.

This webinar was reviewed and re-approved by the on-demand education committee for three years on 5/15/2024.

A need for this educational activity has been determined based on previous course evaluations and the AOFAS educational curriculum. The content of this course was based on current issues and topics provided by AOFAS membership and leadership. For more information on the AOFAS CME mission, visit aofas.org/education.

AOFAS requires all instructors, planners, and other individuals in a position to control or influence the content of an educational activity to disclose all relevant financial relationships or affiliations during the past 12 months with any commercial interest (any entity producing, marketing, re-selling, or distributing healthcare goods and services consumed by, or used on patients). All identified conflicts of interest must be resolved and the education content vetted by AOFAS for fair balance, scientific objectivity, and appropriateness. AOFAS also requires faculty to disclose when off-label/unapproved uses of a product are discussed in a CME activity. AOFAS attests that the persons responsible for the development of this educational activity did so independently and were not influenced by commercial supporters. All financial disclosures will be provided to meeting attendees in the final program materials.

The material presented in this continuing medical education activity has been made available by the American Orthopaedic Foot & Ankle Society (AOFAS) for educational purposes only. This material is not intended to represent the only, nor necessarily the best, methods or procedures appropriate for the medical situation discussed, but rather is intended to present an approach, view, statement, or opinion of the authors or presenters, which may be helpful or of interest to other practitioners. Methods, techniques, and procedures demonstrated and views and opinions expressed by speakers, presenters, and faculty are their own, and do not necessarily represent those of AOFAS, nor does presentation on the program represent or constitute endorsement or promotion by AOFAS. AOFAS expressly disclaims any warranties or guarantees, expressed or implied, and shall not be liable for damages of any kind in connection with the material, methods, information, techniques, opinions, or procedures expressed, presented, or demonstrated.

FDA Statement
Some drugs or medical devices demonstrated at this meeting have not been cleared by the FDA or have been cleared by the FDA for specific purposes only. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each drug or medical devices he or she wishes to use in clinical practice. AOFAS policy provides that “off label” uses of a drug or medical device may be described in its CME activities so long as the “off label” use of the drug or medical device is also specifically disclosed (i.e., it must be disclosed that the FDA has not cleared the drug or device for the described purpose). Any drug or medical device is being used “off label” if the described use is not set forth on the products approval label.

Faculty/Planner Disclosure Declaration
As an Accreditation Council for Continuing Medical Education (ACCME) provider, AOFAS has the obligation to ensure the delivery of education that is balanced and free of commercial bias. To achieve this, it is the policy of the AOFAS that all CME-related board members, committee members (“planners”), faculty, and appropriate staff disclose in writing to the learners’ all financial relationships that you have had in the past 24 months with ineligible companies. An “ineligible company” are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

In addition to faculty members, commentators from the floor are charged with verbally disclosing any interests immediately prior to speaking. All disclosures are provided in this final program distributed at the meeting to all program participants.

In accordance with AOFAS policy:
Faculty participation in this educational activity will be predicated upon timely submission and review of AOFAS disclosure. An individual who refuses to disclose all financial relationships will be disqualified from being a planning committee member, a teacher, or an author of CME, and cannot have control of, or responsibility for, the development, management, presentation, or evaluation of the CME activity. Non-compliance will result in a faculty member being stricken from the program.

An indication of the participant’s disclosure appears after his or her name as well as the ineligible company that provided the support. AOFAS does not view the existence of these disclosed interests or commitments as necessarily implying bias or decreasing the value of the author’s participation in this activity. In addition to ensuring that presentations be free of bias, faculty members are required to ensure that all material presented and discussed will be based on best- available evidence.

John Y Kwon, MD 
Medline: Paid consultant
Medshape: Paid consultant; Stock or stock Options
Paragon 28: IP royalties; Paid consultant
Trimed: IP royalties

Samuel B. Adams, Jr, MD
4web: Paid consultant
American Orthopaedic Foot and Ankle Society: Board or committee member
Medshape: Paid consultant; Stock or stock Options
Orthofix, Inc.: Paid consultant
Regeneration Technologies, Inc.: Paid consultant
Sonoma Orthopaedics: Paid consultant; Paid presenter or speaker
Stryker: Paid consultant

Carroll P. Jones, MD
Acumed, LLC: Research support
American Orthopaedic Foot and Ankle Society: Board or committee member
Amniox: Research support
Arthrex, Inc: IP royalties
Foot and Ankle International: Editorial or governing board
Osteoremedies: Paid consultant
Performance Orthotics: IP royalties
Wright Medical Technology, Inc.: IP royalties; Paid consultant; Research support
Amniox: Paid consultant; Paid presenter or speaker

Anish Kadakia, MD
AAOS: Board or committee member
Acumed, LLC: IP royalties; Paid consultant; Paid presenter or speaker; Research support
American Orthopaedic Foot and Ankle Society: Board or committee member
Arthrex, Inc.: Paid consultant; Paid presenter or speaker
Biomedical Enterprises: IP royalties
BME: IP royalties; Paid consultant
DePuy, A Johnson & Johnson Company: IP royalties
Elsevier: Publishing royalties, financial or material support
Journal of Orthopedic Surgery and Research: Editorial or governing board
LWW: Publishing royalties, financial or material support
Synthes: Research support

Program Planner Disclosures

Michelle Adams: Staff
This individual reported nothing to disclose.

Samuel B. Adams Jr., MD: Board Member-at-Large
4web: Paid consultant
American Orthopaedic Foot & Ankle Society: Board or committee member
MedShape: Paid consultant; Stock or stock Options
Regeneration Technologies, Inc.: Paid consultant
Sonoma Orthopaedics: Paid consultant; Paid presenter or speaker
Stryker: Paid consultant

John G. Anderson, MD: Board Member-at-Large, Webinar Faculty
American Orthopaedic Foot & Ankle Society: Board or committee member
Biomet: Paid consultant
Pfizer: Stock or stock Options
Stryker: IP royalties; Paid consultant; Paid presenter or speaker; Research support
Wright Medical Technology, Inc.: Research support
Zimmer: Research support

Mark J. Berkowitz, MD: Planner
This individual reported nothing to disclose.

John T. Campbell, MD: Planner, Education Committee, Chair
American Orthopaedic Foot & Ankle Society: Board or committee member
Foot & Ankle International: Editorial or governing board
Synthes: Paid consultant
 
J. Chris Coetzee, MD: Board President-Elect
AAOS: Board or committee member
AlloSource: Paid consultant
American Orthopaedic Foot & Ankle Society: Board or committee member
Arthrex, Inc.: IP royalties; Paid consultant; Paid presenter or speaker
Biomet: IP royalties
Elsevier: Publishing royalties, financial or material support
Foot & Ankle International: Editorial or governing board
Integra: Paid consultant; Paid presenter or speaker
Paragon28: Paid presenter or speaker; Stock or stock Options
Stryker: IP royalties
Tornier: Paid consultant; Paid presenter or speaker
Zimmer: Paid consultant

Bruce E. Cohen, MD: Board Treasurer
Acumed, LLC: Research support
American Orthopaedic Foot & Ankle Society: Board or committee member
Amniox: Paid consultant
Arthrex, Inc.: IP royalties
DJ Orthopaedics: IP royalties
TissueTech: Stock or stock Options
Wright Medical Technology, Inc.: IP royalties; Paid consultant

Christopher W. DiGiovanni, MD: Board Secretary
American Orthopaedic Foot & Ankle Society: Board or committee member
Cartiva: Paid consultant
CreOsso: Stock or stock Options
Extremity Medical, Inc.: IP royalties; Paid consultant; Paid presenter or speaker; Stock or stock Options
Foot & Ankle International: Editorial or governing board
Foot and Ankle Surgery (European Journal): Editorial or governing board
Paragon28: Stock or stock Options
Saunders/Mosby-Elsevier: Publishing royalties, financial or material support
Springer: Publishing royalties, financial or material support
Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support
Wright Medical Technology, Inc.: Paid consultant; Paid presenter or speaker; Research support;
Stock or stock Options

Mark E. Easley, MD: Board Past President
Acumed, LLC: Research support
American Orthopaedic Foot & Ankle Society: Board or committee member
Exactech, Inc.: Paid consultant
Journal of Bone & Joint Surgery - American: Editorial or governing board
Orthofix, Inc.: Paid presenter or speaker
Saunders/Mosby-Elsevier: Publishing royalties, financial or material support
SBI: Paid consultant
Stryker: Paid consultant; Paid presenter or speaker
Tornier: Paid consultant; Paid presenter or speaker
TriMed: Paid consultant; Research support
Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support

Alena Frey: Staff
This individual reported nothing to disclose

Daniel C. Farber, MD: Planner
AAOS: Board or committee member
American Orthopaedic Foot & Ankle Society: Board or committee member
Foot & Ankle Orthopaedics: Editorial or governing board
JMEA: Stock or stock Options

Christopher E. Gentchos, MD: Planner
New Hampshire Orthopaedic Society: Board or committee member

Gregory P. Guyton, MD: Board Member-at-Large
American Orthopaedic Foot and Ankle Society: Board or committee member
Arthrex, Inc: Paid consultant
Foot and Ankle International: Editorial or governing board
Paragon 28: Paid consultant
Wright Medical Technology, Inc.: IP royalties; Paid consultant

Steven L. Haddad, MD: Planner
AAOS: Board or committee member
American Orthopaedic Foot & Ankle Society: Board or committee member
Foot & Ankle International: Editorial or governing board
Tornier: Stock or stock Options
Wright Medical Technology, Inc.: IP royalties; Paid consultant

Thomas M. Hearty, MD, DPT: Planner
This individual reported nothing to disclose.

Kaan S. Irgit, MD: Planner
This individual reported nothing to disclose.

Jeffrey E. Johnson, MD: Board Immediate Past President
American Journal of Orthopedics: Editorial or governing board
American Orthopaedic Foot & Ankle Society: Board or committee member
Arthrex, Inc. - Institutional Support for Fellowship: Other financial or material support
Crossroads Medical: Stock or stock Options; Unpaid consultant
Extremity Development Corporation: Stock or stock Options
Foot & Ankle International: Editorial or governing board
Techniques in Foot & Ankle Surgery: Editorial or governing board
Wright Medical Technology, Inc.: IP royalties

Anish R. Kadakia, MD: Planner
AAOS: Board or committee member
Acumed, LLC: IP royalties; Paid consultant; Paid presenter or speaker; Research support
American Orthopaedic Foot & Ankle Society: Board or committee member
Biomedical Enterprises: IP royalties
BME: Paid consultant
Elsevier: Publishing royalties, financial or material support
Journal of Orthopedic Surgery and Research: Editorial or governing board
Lippincott Williams & Wilkins: Publishing royalties, financial or material support
Synthes: Research support

Sandra E. Klein, MD: Board Member-at-Large​
American Orthopaedic Foot & Ankle Society: Board or committee member
Techniques in Foot & Ankle Surgery: Editorial or governing board

L. Daniel Latt, MD, PhD: Planner
AAOS: Board or committee member
American Journal of Sports Medicine: Editorial or governing board
American Orthopaedic Foot and Ankle Society: Board or committee member
Foot and Ankle International: Editorial or governing board
Foot and Ankle Orthopaedics: Editorial or governing board
Footbeat: Unpaid consultant
Guided Therapy Systems: Research support
Medshape: Paid consultant; Stock or stock Options
Orthopaedic Journal of Sports Medicine: Editorial or governing board
Paragon 28: Paid presenter or speaker; Research support
Wright Medical Technology, Inc.: Paid presenter or speaker; Research support

Thomas H. Lee, MD: Board President
American Orthopaedic Foot & Ankle Society: Board or committee member
Bledsoe Corporation: IP royalties
Foot & Ankle International: Editorial or governing board
GLW Medical Innovations: Stock or stock Options
Stryker: IP royalties
Wright Medical Technology, Inc.: IP royalties

Sheldon S. Lin, MD: Planner
American Orthopaedic Foot & Ankle Society: Board or committee member
Biomimetic of Wright: Paid consultant
DJ Orthopaedics: Paid consultant
Foot & Ankle International: Editorial or governing board
TissueGene: Paid consultant

William C. McGarvey, MD: Board Vice President, Council on Education, Chair
American Orthopaedic Foot & Ankle Society: Board or committee member
Journal of the American Academy of Orthopaedic Surgeons: Editorial or governing board
Orthopaedic Knowledge Online Journal: Editorial or governing board
Techniques in Foot & Ankle Surgery: Editorial or governing board
Wright Medical Technology, Inc.: Paid consultant

G. Andrew Murphy, MD: Planner
AAOS: Board or committee member
AlloStem: Research support
American Orthopaedic Foot & Ankle Society: Board or committee member
Arthrex, Inc.: Paid presenter or speaker; Research support
Biomimetic: Research support
Foot & Ankle International: Editorial or governing board
Saunders/Mosby-Elsevier: Publishing royalties, financial or material support
Smith & Nephew: Research support
Wright Medical Technology, Inc.: IP royalties; Paid consultant; Research support

Julie Murkowski: Staff
This individual reported nothing to disclose

Irvin Oh, MD: Planner
This individual reported nothing to disclose.

Cristian A. Ortiz, MD: Planner
Acumed, LLC: Paid presenter or speaker
American Orthopaedic Foot & Ankle Society: Board or committee member
Arthrex, Inc.: Paid consultant; Paid presenter or speaker; Unpaid consultant
DePuy, A Johnson & Johnson Company: Paid presenter or speaker; Unpaid consultant
Smith & Nephew: Paid presenter or speaker

Vinod K. Panchbhavi, MD: Planner
AAOS: Board or committee member
American Orthopaedic Foot & Ankle Society: Board or committee member
Foot & Ankle International: Editorial or governing board
Orthopedia.com: Editorial or governing board
Stryker: Paid presenter or speaker
Techniques in Foot & Ankle Surgery: Editorial or governing board
Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support

Ruth L. Thomas, MD: Planner
AAOS: Board or committee member
American Orthopaedic Foot & Ankle Society: Board or committee member
Foot & Ankle International: Editorial or governing board
Johnson & Johnson: Stock or stock Options
Pfizer: Stock or stock Options
Ruth Jackson Orthopaedic Society: Board or committee member
Stryker: Stock or stock Options
Teva: Stock or stock Options
Zimmer: Stock or stock Options

David B. Thordarson, MD: Planner
American Orthopaedic Foot & Ankle Society: Board or committee member
Bio 2: Paid consultant; Stock or stock Options
Biomet: Paid consultant
Foot & Ankle International: Editorial or governing board; Publishing royalties, financial or material support
OrthoHelix: IP royalties
Paragon28: Stock or stock Options
Stryker: Paid consultant
Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support

Brian M. Weatherford, MD: Planner
BESPA Global: Paid consultant
Orthobullets: Paid consultant

All of the relevant financial relationships listed for these individuals have been mitigated.