Operative Management of Ankle Fractures in Patients with Diabetes Mellitus

Abstract

Most patients with diabetes can undergo open reduction and internal fixation of acute ankle fractures without complications. Patients with absent pedal pulses or peripheral neuropathy are at increased risk for complications.

What are the Patterns of Prophylactic Postoperative Oral Antibiotic Use After Foot and Ankle Surgery?

“…Some authors reported patient age to be an independent predictor for surgical site infections [43,45,59]. Wukich et al [64] did not find this association in 1000 patients undergoing foot and ankle procedures, nor have other studies [17,23,32,36,38,49]. Consistent with the literature, age and hardware placement were infrequent indications for use of prophylactic postoperative oral antibiotics from our participants [13,17,23,32,36,38,49,64].…”

“…Peripheral neuropathy was the strongest predictor of infection [64]. Costigan et al [17] reported infection in 83% of patients with diabetes lacking preoperative pedal pulses and 92% with peripheral neuropathy after surgical treatment for ankle fractures. Numerous studies have supported associations with increased wound complications and surgical site infections in patients with complicated diabetes, peripheral vascular disease, and wound compromising medications [8,16,23,36,43,44,59].…”

“…Investigation to decrease infectious risk in foot and ankle surgery has been largely preoperative, including preoperative risk stratification [17,21,59,64] and evaluation of antiseptic skin preparations [7,12,30,47,48]. An additional measure taken by some foot and ankle surgeons is planned use of a brief course of prophylactic postoperative oral antibiotics after elective outpatient procedures.…”

Osteogenic Protein-1 Overcomes Inhibition of Fracture Healing in the Diabetic Rat: A Pilot Study

“…Type I diabetes mellitus negatively alters the mechanical and biologic properties of bone [3,22] and has been associated with an increased risk of complications with fracture healing, including delayed union, wound necrosis, and increased incidence of infection [6,8,23,25,28]. An intervention that would overcome this inhibition of fracture healing would be useful clinically.…”

“…Type I diabetes mellitus is associated with an increased risk of complications with fractures, including delayed union, wound necrosis, and increased incidence of infection [6,8,23,25,28]. Many of these complications result from progressive small vessel arterial disease and peripheral neuropathy that develop with time and are largely untreatable [19,29].…”