Start with a free account for 12 free CME credits. Already a subscriber? Sign in.

Ankle Fractures

Rob Orman, MD and Uma Ramadorai, DO
00:00
21:16
Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

EM:RAP 2017 January Written Summary 926 KB - PDF

When it comes to ankle fractures, it’s all about how distal and how displaced.

To view chapter written summaries, you need to subscribe.

Sign up today for full access to all episodes.

Patrick B. -

My non-op and op EBM ortho and sportsmed experts are in fairly strong disagreement with the speakers strong suggestion that Achilles injury is best treated nonop. I think the segment seemed a bit biased for the take home message that it was clear cut to not fix most of these....

Rob O -

Here is the response from Dr. Ramadorai.....

Patrick,
My treatment preferences for Achilles tendon treatment is certainly biased. Every surgeon has his/her protocols based on training and hopefully evidence based medicine. The most recent high quality studies concerning operative vs. nonoperative management of Achilles tendon ruptures shows no significant benefit of surgical management when the appropriate nonoperative protocol is employed so that is my preference. In addition, that is what was favored during my fellowship training. The complications that can arise from operative management (whether it be open or percutaneous) can be catastrophic so unless there is a well done prospective study demonstrating a clear superiority of surgical management, I will continue treating them conservatively. That is certainly not the opinion of every orthopaedic surgeon. I am sure if you sat 20 of us down in a room and asked us our preference you would get a wide variety of responses. Ultimately this podcast is for the emergency room provider and the emphasis should be placed on making the diagnosis and getting the patient properly immobilized with appropriate follow-up. The orthopaedic surgeon can then make the decision concerning operative versus nonoperative management with the patient. Please see the below resources.

Nilsson-Helander K, Silbernagel KG, Thomee R, et al. Acute Achilles
tendon rupture: a randomized, controlled study comparing surgical
and nonsurgical treatments using validated outcome measures. Am
J Sports Med. 2010;38(11):2186-2193.
Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical
versus nonsurgical treatment of acute Achilles tendon rupture:
a meta-analysis of randomized trials. J Bone Joint Surg Am.
2012;94(23):2136-2143.
Wallace RG, Heyes GJ, Michael AL. The non-operative functional
management of patients with a rupture of the tendo Achillis leads
to low rates of re-rupture. J Bone Joint Surg Br. 2011;93(10):1362-
1366.
4. Willits K, Amendola A, Bryant D, et al. Operative versus nonoperative
treatment of acute Achilles tendon ruptures: a multicenter randomized
trial using accelerated functional rehabilitation. J Bone Joint
Surg Am. 2010;92(17):2767-2775.

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Broken Ankles, Ribs, and Pumps Full episode audio for MD edition 227:43 min - 318 MB - M4AEM:RAP 2017 January Canadian Edition Canadian 22:10 min - 31 MB - MP3EM:RAP 2017 January Australian Edition Australian 43:30 min - 60 MB - MP3EM:RAP 2017 January German Edition Deutsche 90:03 min - 124 MB - MP3EM:RAP 2017 January French Edition Français 32:33 min - 45 MB - MP3EM:RAP 2017 January Spanish Edition Español 65:46 min - 90 MB - MP3EM:RAP 2017 January Board Review Answers 220 KB - PDFEM:RAP 2017 January Board Review Questions 202 KB - PDFEM:RAP 2017 January Separate MP3 Files 265 MB - ZIPEM:RAP 2017 January Spanish Written Summary 1 MB - PDFEM:RAP 2017 January Written Summary 926 KB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

0.25 Free AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate

4.25 AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate