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Letters to the Editor   |    
Stress Test for Predicting the Need for Surgical Fixation of Fibular Fractures
Dhiren S. Sheth, MD; Catherine G. Ambrose, PhD
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The authors did not receive grants or outside funding in support of their research or preparation of this work. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 May 01;87(5):1165-1165
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To The Editor:We reviewed the article "Ankle Stress Test for Predicting the Need for Surgical Fixation of Isolated Fibular Fractures" (2004;86: 2393-8), by Egol et al., at our monthly journal club. We are writing this letter on behalf of our journal club.A number of conclusions made by the authors were not supported by the data presented in the paper. The authors stated that the study supported an algorithm that directs patients with a negative stress radiograph and no medial symptoms to be treated nonoperatively. However, the only data supporting this conclusion was that "all of the thirty-five patients... had clinical and radiographic evidence of healing." No functional or follow-up radiographic data were provided. This group had a supination-external rotation stage-II pattern of injury, and nonoperative management is accepted as the standard of care. However, a more detailed analysis of this group to support the authors' impression would be helpful.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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