AO Trauma Curriculum ModuleOverview Foot and Ankle

Module overviewAO Trauma Foot and Ankle CurriculumApproved by the AO Trauma Education Commission June 2014(Last update: 31.10.2016)

IntroductionThe AO Trauma Courses for foot and ankle are modular face-to-face educational events further complemented by expert modules/symposia and self-directed learning opportunities, eg, resources, webinars, videos. All content is designed to be globally applicable and adaptable to regional differences, depending on participant needs, regional and local requirements and logistical considerations without impacting the essential content to be covered—the knowledge, skills, and attitudes to apply the current principles and techniques of foot and ankle injury management.

Modular structure Traditional courses tried to cover as much content and be as comprehensive as possible. However, this modular curriculum provides chairpersons with a range of foot and ankle options to combine for the educational event of their preference with the highest relevance to their audience. Ready-to-use course templates as well as modules of approximately half-day and quarter-day duration are available and can be combined for a highly customized course. Individual or combinations of modules can also be run as stand-alone seminars. A special full-day anatomical specimen workshop is offered for those who have the relevant infrastructure available.

Developed by the AO Trauma Foot and Ankle Education Taskforce

International Program Editors (IPEs) Regional Program Contributors (RPCs)

• Stefan Rammelt• Michael Swords• Mandeep Dhillon• Past members: Christina Kabbash, Per-Henrik Agren,

Les Grujic, Marcos Sakaki

• Europe—Martijn Poeze• Latin America—Luis Cadena, Daniel Nino Gomez• Middle East—Ahmed Kholeif• North America— Stephen Benirschke,

Michael Castro, Andrew SandsProject contact

Jane Wiedler ([email protected])

Link to AO Trauma Foot and Ankle Curriculum website

https://aotrauma.aofoundation.org/Structure/education/educational-programs/foot-ankle

Link to AO Trauma Foot and Ankle Faculty Support Package

https://aotrauma.aofoundation.org/Structure/faculty-center/Pages/faculty-center.aspx (login required)

2 Module overview: AO Trauma Foot and Ankle Curriculum

Competency-based curriculumThe development of this course followed a backward planning process leading to a competency-based curriculum—please refer to the Competency Booklet PDF.This course may be approved to carry the AO Competency-Based Curriculum stamp. See separate document for criteria and more information.

Chairperson GuidePlease also check the Chairperson Guide in the Faculty Support Package for the course goal, overall learning objectives, target participants, faculty preparation, logistics, and much more about the specifics of this course.

Overview of all modules

Introduction session

Trauma Module 1 (a and b) Ankle trauma 4.5 hours

Trauma Module 2 (a and b) Hindfoot trauma 4.5 hours

Optional Trauma Module 3 Minimally invasive osteosynthesis 3.5 hours

Trauma Module 4 (a and b) Midfoot trauma 5 hours

Trauma Module 5 Forefoot trauma 2 hours

Trauma Module 6 Soft-tissue trauma 2 hours

Recon Module 7 Ankle arthritis 3 hours

Recon Module 8 Hindfoot arthritis 4 hours

Recon Module 9 Acquired flatfoot deformity 3 hours

Recon Module 10 Cavus 2.5 hours

Optional Recon Module 11 Tendon transfers/neuromuscular 2 hours

Optional Recon Module 12 Charcot 2 hours

Optional Recon Module 13 Midfoot reconstruction 2 hours

Optional Recon Module 14 The great toe 3.5 hours

Optional Recon Module 15 The lesser toes 2 hours

Optional Sports Module 16 Sports injuries 3.5 hours

Special Module 17 Anatomical specimen workshops full day

Closing session

Module overview: AO Trauma Foot and Ankle Curriculum 3

Module Overview—Trauma Modules

Module 1—Ankle trauma ½ dayAt the end of this module, participants should be able to:

• Correctly identify and treat ankle fractures and associated soft-tissue injuries• Conduct appropriate investigations for a preoperative plan of fracture fixation• Utilize appropriate surgical incisions • Restore ankle anatomy using adequate reduction techniques• Explain current management principles for patients with ankle fractures• Identify, prevent, and treat complications associated with ankle fractures and fracture dislocations

Module 1a—Ankle fractures

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important points

Small group discussions Medial malleolus Fibular, bimalleolar, trimalleolar SyndesmosisPlenary session Report back from discussion groups Faculty panel/debate with some special cases including questions from participants

Module 1b—Pilon fracturesSmall group discussions Pilon fractures

Plenary session Faculty panel/debate including questions from participants

Practical exercise Pilon fracture (video 24028)

Module 2—Hindfoot trauma ½ dayAt the end of this module, participants should be able to:

• Correctly identify and treat hindfoot fractures and associated soft-tissue injuries• Conduct appropriate investigations for a preoperative plan of fracture fixation• Utilize appropriate surgical incisions • Restore hindfoot anatomy using adequate reduction techniques• Explain current management principles for patients with hindfoot fractures• Identify, prevent, and treat complications associated with hindfoot fractures and dislocations

Module 2a—Calcaneal fractures

Keynote lecture Either as intro or summary to emphasize a viewpoint or sum up important points

Small group discussions Calcaneal fractures


Module 2b—Talar fractures

Small group discussions Talar fractures


Practical exercise Calcaneus fracture (video 24026)


Module 3—Minimally invasive osteosynthesis ½ dayAt the end of this module, participants should be able to:

• Recognize importance of timing for reduction• Differentiate between minimally invasive vs open procedures• Discuss open vs minimal incisions• Describe and apply minimally invasive techniques including reduction, use of C-arm etc• Describe the indications and advantages/disadvantages of MIS


Master-table demonstrations | Ankle | Pilon | Arthroscopic assisted surgery Method depending on available technology | Calcaneus | Talus Small group discussions Revisit previous cases and discuss if/how they can be managed with MIO techniques


Module 4—Midfoot trauma ½ dayAt the end of this module, participants should be able to:

• Correctly identify and treat midfoot fractures and associated soft-tissue injuries• Conduct appropriate investigations for a preoperative plan of fracture fixation• Utilize appropriate surgical incisions • Restore midfoot anatomy using adequate reduction techniques• Explain current management principles for patients with midfoot fractures• Identify, prevent, and treat complications associated with midfoot fractures and dislocations

Module 4a—Lisfranc fractures


Small group discussions Lisfranc fractures


Module 4b—Chopart/navicular fractures

Small group discussions Navicular fractures, cuboid fractures, Chopart fracture dislocations


Practical exercise Lisfranc fractures (video 24039)


Module 5—Forefoot trauma ¼ dayAt the end of this module, participants should be able to:

• Correctly identify and treat forefoot fractures and associated soft-tissue injuries• Conduct appropriate investigations for a preoperative plan of fracture fixation• Utilize appropriate surgical incisions • Restore forefoot anatomy using adequate reduction techniques• Explain current management principles for patients with forefoot fractures• Identify, prevent, and treat complications associated with forefoot fractures and dislocations

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions Metatarsal fractures Jones fractures Sesamoid fracturesPlenary session Faculty panel/debate including questions from participants

Module 6—Soft-tissue trauma ¼ dayAt the end of this module, participants should be able to:

• Manage soft-tissue defects effectively• Ensure adequate soft-tissue coverage and appropriate timing of fracture fixation• Identify compartment syndrome and prevent its sequelae• Identify and treat Complex Regional Pain Syndrome (CRPS)• Explain the indications and techniques for amputation• Discuss salvage vs amputation

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsLecture Soft-tissue principlesSmall group discussions Open fractures Compartment syndrome Crush injuries/mangled foot AmputationPlenary session Faculty panel/debate including questions from participants


Module Overview—Reconstruction Modules

Module 7—Ankle arthritis ½ dayAt the end of this module, participants should be able to:

• Recognize treatment options for ankle arthritis• Recognize indications for surgical approach with respect for correction of deformity• Perform joint preparation techniques and rigid fixation

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions Fusion (open or SCOPE) Plenary session Faculty panel/debate including questions from participantsSmall group discussions Osteotomies and total ankle replacementPlenary session Faculty panel/debate including questions from participantsPractical exercise Ankle fusion anterior (video 24032)Practical exercise Ankle fusion transfibular (video 24033)Practical exercise Ankle fusion with SCOPE for anatomical specimen workshop (video 24034)

Module 8—Hindfoot arthritis ½ dayAt the end of this module, participants should be able to:

• Recognize treatment options for hindfoot arthritis• Recognize indications for surgical approach with respect for correction of deformity• Perform appropriate salvage procedures

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions Coalitions and fusions (open or SCOPE) Posttraumatic arthritis and deformities Plenary session Faculty panel/debate including questions from participantsSmall group discussions Tibial talar calcaneal (TTC) fusion (screws/plates/nail)Plenary session Faculty panel/debate including questions from participantsPractical exercise Subtalar bone block arthrodesis (reorientating distraction fusion) (video 24025)Practical exercise Hindfoot Arthrodesis Nail (video 24029)

Module 9—Acquired flatfoot deformity ½ dayAt the end of this module, participants should be able to:

• Recognize treatment options for flatfoot deformity• Differentiate between the various treatment options

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions Flexible flatfoot, eg, Accessory navicular Kidner, Spring ligament construction/repair,

FDL transfer and fixation techniques to navicular, Lateral column lengthening, Arthroeresis (sinus tarsi implant, application), NC arthrodesis for flatfoot, Tendo-achilles lengthening, Calcaneal osteotomy, Cotton osteotomy/Lapidus procedure

Small group discussions Rigid flatfoot and fusionsPlenary session Faculty panel/debate including questions from participantsPractical exercise Calcaneal tuberosity (video 24030)


Module 10—Cavus ½ dayAt the end of this module, participants should be able to:

• Describe cavovarus and compensated hindfoot varus• Recognize treatment options for cavus deformities

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions Flexible Cavus Jones chronic fracture Cavus foot osteotomy and/or fusion Tendon transfers (eg, Jones, Hibb’s, T-SPOTT, SPLATT, Peroneus longus-to-brevis)Plenary session Faculty panel/debate including questions from participantsSmall group discussions Rigid Cavus Cavus foot osteotomy and/or fusion Tendon transfers Jones chronic fracturePlenary session Faculty panel/debate including questions from participantsPractical exercise Calcaneal tuberosity (video 24030)

Module 11—Tendon transfers/neuromuscular ¼ day At the end of this module, participants should be able to:

• Explain tendon balancing• Differentiate between dynamic vs static• Consider neuromuscular conditions (stroke, CMT, MS, post-polio, etc)• Identify and treat missed posterior compartment syndrome

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions Tendon transfers Foot drop, SPLATT Eversion and inversion reconstruction Compartment syndrome FHL reconstruction/achillesPlenary session Faculty panel/debate including questions from participants

Module 12—Charcot ½ dayAt the end of this module, participants should be able to:

• Discuss timing to fixation in charcot—3 stages• Describe the progression and treatment of charcot foot• Describe the appropriate treatment of charcot midfoot, hindfoot, and ankle

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions Charcot midfootSmall group discussions Charcot hindfoot and anklePlenary session Faculty panel/debate including questions from participantsPractical exercise Midfoot fusion bolt (24031 video)Practical exercise Midfoot Charcot deformity correction (video 24038)


Module 13—Midfoot ¼ dayAt the end of this module, participants should be able to:

• Recognize treatment options for midfoot arthritis and deformity• Recognize the importance of alignment

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions TMT fusions/correction of deformity 4th and 5th TMT arthritis unsolved problem (longer session using ARS/debate)Plenary session Faculty panel/debate including questions from participants

Module 14—The great toe ½ dayAt the end of this module, participants should be able to:

• Recognize the causes of hallux valgus and address reconstruction appropriately• Recognize treatment options for hallux rigidus

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussion Hallux rigidusSmall group discussion Hallux valgus and failed bunionPlenary session Faculty panel/debate including questions from participantsPractical exercise First MTPJ fusion (video 24035)Practical exercise Scarf osteotomy (video 24037)Practical exercise Lapidus (video 24036)

Module 15—The lesser toes ¼ dayAt the end of this module, participants should be able to:

• Recognize treatment options for lesser toe deformities and conditions

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions Rheumatoid forefoot Hammer toe deformities Metatarsalgia Plantar plate repair Morton’s Neuroma Freiberg disease BunionettePlenary session Faculty panel/debate including questions from participants


Module 16—Sports injuries ½ dayAt the end of this module, participants should be able to:

• Recognize ankle instability and associated issues• Consider repair vs casting/bracing for Achilles ruptures • Manage tendon pathology• Identify and treat stress fractures

Keynote lecture Either intro or summary to emphasize a viewpoint or sum up important pointsSmall group discussions Achilles tendon pathology Stress fractures Turf toe and sesamoid fractures Plantar fasciitisPlenary session Faculty panel/debate including questions from participantsSmall group discussions Peroneal retinacular sheath disruption Peroneal tendon tears Ankle instability (syndesmosis and lateral ligaments) Talar osteochondral lesionsPlenary session Faculty panel/debate including questions from participantsPractical exercise Brostrom/lateral ligament reconstruction +/- graft

Module 17—Anatomical specimen workshops Full dayAt the end of this module, participants should be able to:

• Perform surgical approaches according to the selected procedure• Address management of soft-tissues according to the selected procedure

Procedures matching the course content and regional needsContent grouped in order to provide maximum approaches on two specimens Specimen 1Talar neck fracture approaches Talar dome exposure; fibular and medial malleolar osteotomies Gastroc slide (ensure long enough specimens) Lapidus Plantar plate repair Minimally invasive approach for calcaneal fractures Sustentacular approach for calcaneal fractures Pilon approachesSpecimen 2Posterior ankle scope Subtalar arthroscopy SPLATT Interosseous tibialis posterior tendon transfer Extensile lateral approach for calcaneal fractures Posterior bone block arthrodesis Compartment syndrome release (foot/leg) 1st metatarsal osteotomy for the correction of hallux valgus 1st MTPJ fusion FHL tendon transfer for Achilles or peroneal insufficiency FDL tendon transfer for flatfoot

Documents

AO Trauma Curriculum ModuleOverview Foot and Ankle