Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

Nash, William; Hester, Thomas; Ha, Joon Soo

doi:10.1016/j.jcot.2021.01.016

Cited by 12 publications

(10 citation statements)

References 46 publications

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“…Also, additional studies are required to provide a clinically meaningful difference in the outcomes. This was also suggested in previous similar meta‐analysis studies, which showed a similar effect of negative pressure wound therapy and conventional wound dressings in subjects with different types of orthopaedic trauma surgery 32‐40 . The insignificant results of negative pressure wound therapy in the length of hospital stay also need additional study and clarification because no clear reasoning was found to clarify these outcomes.…”

Section: Discussionmentioning

confidence: 66%

“…This was also suggested in previous similar meta-analysis studies, which showed a similar effect of negative pressure wound therapy and conventional wound dressings in subjects with different types of orthopaedic trauma surgery. [32][33][34][35][36][37][38][39][40] The insignificant results of negative pressure wound therapy in the length of hospital stay also need additional study and clarification because no clear reasoning was found to clarify these outcomes. Wellconducted studies are also required to measure these factors and the blend of different ages and ethnicity, because our meta-analysis study could not answer whether they are related to the outcomes.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta‐analysis

Xie

Dai

et al. 2021

International Wound Journal

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We performed a meta-analysis to evaluate the effect of negative pressure wound therapy compared with conventional wound dressings on closed incisions in orthopaedic trauma surgery. A systematic literature search up to October 2021 was done and 12 studies included 3555 subjects with closed incisions in orthopaedic trauma surgery at the start of the study: 1833 of them were provided with negative pressure wound therapy and 1722 were conventional wound dressings. They were reporting relationships about the effect of negative pressure wound therapy compared with conventional wound dressings on closed incisions in orthopaedic trauma surgery. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to assess the effect of negative pressure wound therapy compared with conventional wound dressings on closed incisions in orthopaedic trauma surgery using the dichotomous and continuous methods with a random or fixed-effect model. Negative pressure wound therapy had significantly lower deep surgical site infection (OR, 0.65; 95% CI, 0.48-0.88, P = .005), superficial surgical site infection (OR, 0.23; 95% CI, 0.11-0.49, P = .31), and wound dehiscence (OR, 0.41; 95% CI, 0.21-0.80, P = .009) compared with conventional wound dressings in subjects with closed incisions in orthopaedic trauma surgery. However, negative pressure wound therapy had no significant effect on the length of hospital stay (MD, 0.29; 95% CI, À2.00-2.58, P = .80) compared with conventional wound dressings in subjects with closed incisions in orthopaedic trauma surgery. Negative pressure wound therapy had significantly lower deep surgical site infection, superficial surgical site infection, and wound dehiscence; however, negative pressure wound therapy had no beneficial effect on the length of hospital stay compared with conventional wound dressings in subjects with closed incisions in orthopaedic trauma surgery.Further studies are required to validate these findings.Weiwei Xie and Lingyan Dai contributed equally to this study.

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Section: Discussionmentioning

confidence: 66%

Section: Resultsmentioning

confidence: 99%

Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta‐analysis

Xie

Dai

et al. 2021

International Wound Journal

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“…7,12,32 Specifically, diabetes has been associated with higher complication rates including delayed bone healing, increased wound complications, and increased infection rates. 20 Mehta et al 18 reports an infection rate as high as 60% in diabetes patients undergoing ORIF. Patients with bleeding disorders in our study were not more likely to have diabetes, but were more likely to have other comorbidities compared to patients without bleeding disorders.…”

Section: Discussionmentioning

confidence: 99%

“…17 Prior studies have found that patients with comorbidities such as diabetes, peripheral neuropathy, and osteoporosis were at an increased risk for postoperative complications and worse functional outcomes following ORIF. 20,32 Age, body mass index (BMI), and history of smoking were also identified as risk factors associated with a higher rate of complications. 7 Common complications following ORIF include surgical site infections and thromboembolic events.…”

Section: Introductionmentioning

confidence: 99%

Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle

et al. 2021

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Background: Open reduction and internal fixation (ORIF) of the ankle is a common procedure performed to correct ankle fractures in many different patient populations. Diabetes, peripheral vascular disease, and osteoporosis have been identified as risk factors for postoperative complications following surgery for ankle fractures. To date, there have not been any studies evaluating postoperative outcomes in patients with bleeding disorders undergoing operative treatment for ankle fractures. The aim of this study was to determine the postoperative complication rate following ORIF of the ankle in patients with a bleeding disorder vs those without a bleeding disorder. Methods: From 2006 to 2018, patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database. Two patient cohorts were defined: patients with a bleeding disorder and patients without a bleeding disorder. Patients who underwent either inpatient or outpatient ORIF of the ankle were included in this study. In this analysis, demographics, medical comorbidities, and postoperative complications variables were assessed between the 2 cohorts. Bivariate and multivariate analyses were performed. Results: Of 10 306 patients undergoing operative treatment for ankle fracture, 9909 patients (96.1%) had no bleeding disorder whereas 397 patients (3.9%) had a bleeding disorder. Following adjustment on multivariate analysis, compared to patients who did not have a bleeding disorder, those with a bleeding disorder had an increased risk of any postoperative complications (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.05-2.08, P = .024), requirement for postoperative blood transfusion (OR 2.86, 95% CI 1.53-5.36, P = .001), and extended length of hospital stay greater than 5 days (OR 1.46, 95% CI 1.10-1.93, P = .010). Conclusion: Patients with bleeding disorders are associated with increased risk of postoperative complications following ORIF for ankle fractures. Determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with bleeding disorders undergoing ORIF can be beneficial in reducing postoperative complications, improving patient outcomes, and reducing overall morbidity. Level of Evidence: Level III, retrospective cohort study.

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“…In summary of outcomes literature of diabetic ankle fractures, complication rates ranged from 14% to 36%, all infections 12% to 36%, and deep infections 7% to 10% 50,51,54,55 . This emphasizes the challenges in this patient population.…”

Section: Operative Techniques and Considerations Open Reduction And I...mentioning

confidence: 99%

Ankle Fractures in Diabetic Patients

2023

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Patients with diabetes are at higher risk for complications after surgical fixation of unstable fractures due to impaired neurovascular functioning and wound-healing capabilities.Patients with uncontrolled diabetes have higher rates of complications when compared with patients with controlled diabetes.Despite higher rates of complications, operative fixation of unstable ankle fractures in diabetic patients reliably leads to a functional lower extremity with an overall lower rate of complications than nonoperative management.Operatively and nonoperatively managed ankle fractures in patients with diabetes should remain non–weight-bearing for an extended period of time.Discussion of risk of poor outcomes including deep infection, loss of reduction, return to the operating room, and risk of arthrodesis or amputation should be explicitly discussed with patients and families when managing unstable ankle fractures in diabetic patients.

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Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

Cited by 12 publications

References 46 publications

Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta‐analysis

Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta‐analysis

Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle

Ankle Fractures in Diabetic Patients

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