Ankle Fractures in Diabetic Patients

Goldberg, Ellen M; Polachek, William S.; Hynes, Kelly

doi:10.2106/jbjs.rvw.22.00147

Cited by 2 publications

(1 citation statement)

References 74 publications

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“…It is known that the operative treatment of pilon fractures leads to improved functional outcomes at the risk of higher surgical complications in diabetic patients. 14 Identification and characterization of the specific risks is paramount to mitigating adverse outcomes. Previous literature comparing short-term outcomes of surgically treated pilon fractures with and without diabetes identified higher rates of infection and nonunion/delayed union in diabetic patients but did not characterize amputations or rate of reoperations.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Surgically Treated Pilon Fractures: A Comparison of Patients with and without Diabetes

Chowdary,

Ravi,

Wukich

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: Compare systemic complications, fracture healing related complications, and reoperation rates for pilon fractures in patients with and without diabetes. Design: Retrospective cohort study. Setting: National administrative claims database with patient records. Patients: Patients from the years 2016 to 2020 with surgically treated closed or open pilon fractures. Intervention: Patients with either closed or open pilon fractures with diabetes were compared to those without diabetes. Subgroup analysis was performed on diabetic patients with and without neuropathy. Outcomes: Postoperative systemic complications at 90 days, fracture healing complications at 90 days and 1 year, and reoperative rates at 90 days and 1 year. Results: 2,654 (31.4%) patients with closed fractures and 491 (28.7%) patients with open fractures had a diagnosis of diabetes. In both open and closed fractures, we identified significantly higher rates of acute kidney injury, cardiac arrest, and surgical site infection in diabetic patients compared to non-diabetic patients. Additionally, we found significantly higher rates of below knee amputations in diabetic patients. Diabetic patients with closed fractures had significantly higher rates of wound healing related reoperations. Patients with advanced diabetic disease, as suggested by the presence of neuropathy, had higher rates of nonunions and post-traumatic arthritis. Conclusions: The data presented here provides updated estimates on complication rates in pilon fractures using large sample size. Additionally, our work identifies differences in outcomes for patients with and without diabetes following pilon fracture surgery. Our data suggests that patients with severe diabetes are prone to higher rates of healing complications and may benefit from additional therapeutic support. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Surgically Treated Pilon Fractures: A Comparison of Patients with and without Diabetes

Chowdary,

Ravi,

Wukich

et al. 2023

Journal of Orthopaedic Trauma

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Surgical Management of Complex Ankle Fractures in Patients with Diabetes: A National Retrospective Multicentre Study

Ahluwalia,

Wek,

Lewis

et al. 2024

JCM

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Objectives: Patients with ankle fractures associated with diabetes experience more complications following standard open reduction–internal fixation (ORIF) than those without diabetes. Augmented fixation strategies, namely extended ORIF and hindfoot nails (HFNs), may offer better results and early weightbearing in this group. The aim of this study was to define the population of patients with diabetes undergoing primary fixation for ankle fractures. Secondarily, we aimed to assess the utilisation of standard and augmented strategies and the effect of these choices on surgical outcomes, including early post-operative weightbearing and surgical complications. Methods: A national multicentre retrospective cohort study was conducted between January and June 2019 in 56 centres (10 major trauma centres and 46 trauma units) in the United Kingdom; 1360 patients with specifically defined complex ankle fractures were enrolled. The patients’ demographics, fixation choices and surgical and functional outcomes were recorded. Statistical analysis was performed to compare high-risk patients with and without diabetes. Results: There were 316 patients in the diabetes cohort with a mean age of 63.9 yrs (vs. 49.3 yrs. in the non-diabetes cohort), and a greater frailty score > 4 (24% vs. 14% (non-diabetes cohort) (p < 0.03)); 7.5% had documented neuropathy. In the diabetes cohort, 79.7% underwent standard ORIF, 7.1% extended ORIF and 10.2% an HFN, compared to 87.7%, 3.0% and 10.3% in the non-diabetes cohort. Surgical wound complications after standard-ORIF were higher in the diabetes cohort (15.1% vs. 8.7%) (p < 0.02), but patients with diabetes who underwent augmented techniques showed little difference in surgical outcomes/complications compared to non-diabetes patients, even though early-weightbearing rates were greater than for standard-ORIF. Conclusions: Ankle fractures in diabetes occur in older, frailer patients, whilst lower-than-expected neuropathy rates suggest a need for improved assessment. Augmented surgical techniques may allow earlier weightbearing without increasing complications, in keeping with modern guidelines in ankle fracture management.

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Ankle Fractures in Diabetic Patients

Cited by 2 publications

References 74 publications

Outcomes of Surgically Treated Pilon Fractures: A Comparison of Patients with and without Diabetes

Outcomes of Surgically Treated Pilon Fractures: A Comparison of Patients with and without Diabetes

Surgical Management of Complex Ankle Fractures in Patients with Diabetes: A National Retrospective Multicentre Study

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