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2023 Journal CME: Racial disparities in early adverse events and unplanned readmission after open fixation of fractures distal to the knee

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Accreditation Statement: The Orthopaedic Trauma Association (OTA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation:  OTA designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Learning Objectives

After completing this activity, learners will be able to:

1. Describe the limitations of database studies that assess racial disparities
2. Describe how patient race relates to 30-day adverse events, readmission, and time to surgery
3. List which postoperative complications are more commonly seen in black vs. white patients following operative fixation of fractures distal to the knee


  • Author: Amy L. Xu, BS

Original release date: 7/6/2023

Expiration date: 7/6/2024

Estimated time to complete activity: 1 hour

Statement of Need/Description/or Summary of Gap Analysis:

Previous studies have established race-based differences in surgical management of hip fractures and pathologic fractures of the lower extremity.1-5 Despite the high volume of fractures that occur distal to the knee, studies assessing racial disparities in their management are lacking. It is essential for providers to have awareness of the presentation of racial disparities for common orthopaedic pathologies in order to plan interventions to lessen them.

1. Dy CJ, Lane JM, Pan TJ, Parks ML, Lyman S. Racial and Socioeconomic Disparities in Hip Fracture Care. J Bone Joint Surg Am. 2016;98(10):858-865. doi:10.2106/JBJS.15.00676
2. Ali I, Vattigunta S, Jang JM, et al. Racial Disparities are Present in the Timing of Radiographic Assessment and Surgical Treatment of Hip Fractures. Clin Orthop. 2020;478(3):455-461. doi:10.1097/CORR.0000000000001091
3. Raad M, Puvanesarajah V, Wang KY, et al. Do Disparities in Wait Times to Operative Fixation for Pathologic Fractures of the Long Bones and 30-day Complications Exist Between Black and White Patients? A Study Using the NSQIP Database. Clin Orthop. Published online August 6, 2021. doi:10.1097/CORR.0000000000001908
4. Nayar SK, Marrache M, Ali I, et al. Racial Disparity in Time to Surgery and Complications for Hip Fracture Patients. Clin Orthop Surg. 2020;12(4):430-434. doi:10.4055/cios20019
5. Ryan DJ, Yoshihara H, Yoneoka D, Egol KA, Zuckerman JD. Delay in Hip Fracture Surgery: An Analysis of Patient-Specific and Hospital-Specific Risk Factors. J Orthop Trauma. 2015;29(8):343-348. doi:10.1097/BOT.0000000000000313

Instructional Format: This Orthopaedic Trauma Association International Journal CME activity consists of a journal article, a quiz, and an evaluation.

Method of Participation: There are no fees for members to participate in this activity. Non-members must pay $30. This online activity consists of an article, a self-assessment exam, and an evaluation. To receive AMA PRA Category 1 Credit™ credit, participants must read the journal article, successfully complete the post-test quiz, and achieve a minimum score of 75% on the quiz. The quiz includes 4 multiple choice questions. Learners will be asked to read each question, select an answer, and review the section of the article where the answer is found. Learners will be able to review the content and repeat the quiz as many times as needed. Upon achieving a score of 75% or higher, learners will be asked to complete a post-activity evaluation. A certificate of credit or participation will be available upon successful submission of the post-activity evaluation.


The Orthopaedic Trauma Association has implemented a policy to comply with the current Accreditation Council for Continuing Medical Education (ACCME) Standards for Integrity and Independence in Accredited Continuing Education requiring mitigation of all conflicts of interest. Faculty declaring a relevant commercial interest must be identified in the activity syllabus and/or program.

In accordance with disclosure policies of OTA and the ACCME, every effort has been made to ensure all CME activities are balanced, independent, objective, and scientifically rigorous. These policies include complying with ACCME’s Standards for Integrity and Independence in Accredited Continuing Education and mitigating all relevant conflicts of interest for all individuals in control of content.  

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

All disclosures are available on the "Disclosure" tab.

Disclaimer: The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by the OTA.  In no event will the OTA be liable for any decision made or action taken in reliance upon the information provided through this CME activity.

Commercial Support: There is no commercial support for this activity


Read the CME Article
Open to download resource.
Open to download resource. Please read the OTAI Journal CME Article by downloading the attached PDF.
4 Questions  |  Unlimited attempts  |  3/4 points to pass
4 Questions  |  Unlimited attempts  |  3/4 points to pass Please complete the following multiple-choice quiz. You must achieve 75% or higher to pass.
8 Questions
8 Questions Please complete the activity evaluation to claim CME credit for this course.
CME Certificate
Up to 1.00 medical credits available  |  Certificate available
Up to 1.00 medical credits available  |  Certificate available