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Ankle Fractures

An Expert Survey of Orthopaedic Trauma Association Members and Evidence-Based Treatment Recommendations

Coles, Chad P. MD*; Tornetta, Paul III MD; Obremskey, William T. MD, MMHC, MPH; Spitler, Clay A. MD§; Ahn, Jaimo MD; Mirick, Gudrun MD; Krause, Peter MD**; Nana, Arvind MD††; Rodriguez-Buitrago, Andres MD the Orthopaedic Trauma Association's Evidence-Based Quality Value and Safety Committee

doi: 10.1097/BOT.0000000000001503
Opinions and Surveys

Objectives: To describe current practice patterns of orthopaedic trauma experts regarding the management of ankle fractures, to review the current literature, and to provide recommendations for care based on a standardized grading system.

Design: Web-based survey.

Participants: Orthopaedic Trauma Association (OTA) members.

Methods: A 27-item web-based questionnaire was advertised to members of the OTA. Using a cross-sectional survey study design, we evaluated the preferences in diagnosis and treatment of ankle fractures.

Results: One hundred sixty-six of 1967 OTA members (8.4%) completed the survey (16% of active members). There is considerable variability in the preferred method of diagnosis and treatment of ankle fractures among the members surveyed. Most responses are in keeping with best evidence available.

Conclusions: Current controversy remains in the management of ankle fractures. This is reflected in the treatment preferences of the OTA members who responded to this survey.

Level of Evidence: Therapeutic Level V. See Instructions for authors for a complete description of levels of evidence.

*Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada;

Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA;

Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN;

§Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS;

Department of Orthopaedic Surgery, University of Pennsylvania Medical Center, Philadelphia, PA;

Department of Orthopaedic Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN;

**Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA; and

††Department of Orthopaedic Surgery, John Peter Smith, Fort Worth, TX.

Reprints: Chad P. Coles, MD, Suite 4856, New Halifax Infirmary, 1796 Summer St, Halifax, NS, Canada B3H 3A7 (e-mail:

The authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted April 23, 2019

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