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CME OnDemand: Difficult Ankle Fractures
Difficult Ankle Fractures

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


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.

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

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.

Statement of Need

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


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

Learn more about the AOFAS CME Program Mission 

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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.

Availability: On-Demand
Expires on 03/01/2023
Cost: Member: $15.00
Non-Member: $59.00
Credit Offered:
1 CME (MD) OnDemand Credit
1 CME (PA/NP/RN) OnDemand Credit
American Orthopaedic Foot & Ankle Society®
Orthopaedic Foot & Ankle Foundation
9400 W. Higgins Road, Suite 220, Rosemont, IL 60018
800-235-4855 or +1-847-698-4654 (outside US)
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