The Impact of Diabetes on Patient Outcomes After Ankle Fracture

Ganesh, Shanthi; Pietrobon, Ricardo; CEĆLIO, WILLIAM A.C.; Pan, Deng; Lightdale, Nina; Nunley, James A.

doi:10.2106/00004623-200508000-00007

Cited by 27 publications

(33 citation statements)

References 10 publications

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“…Another study showed, that diabetic patients have an increased mortality rate, more postoperative complications, longer in-hospital stay, and elevated costs compared to non-diabetic patients (Ganesh et al 2005). Additionally, diabetic patients with neuro-or vasculopathy have a 6-fold risk of overall complications following ankle fracture surgery compared to patients with uncomplicated diabetes (Jones et al 2005, Wukich and Kline 2008, Wukich et al 2010, Wukich et al 2011.…”

Section: Diabetic Patientsmentioning

confidence: 99%

Complications in ankle fracture surgery

Ovaska¹

2015

Acta Orthop

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Section: Diabetic Patientsmentioning

confidence: 99%

Complications in ankle fracture surgery

Ovaska¹

2015

Acta Orthop

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“…3 In patients undergoing ankle fracture surgery, diabetes is associated with higher rates of morbidity (infection, mal-union, delayed and non-union, amputation, length of hospital stay) and mortality. 4,5 Complication rates for such patients have been reported to be as high as 42 to 60%. [6][7][8] Infection may result in further morbidity, loss of function, and even mortality.…”

Section: Abstract: Ankle Fractures; Diabetes Mellitus; Surgical Wounmentioning

confidence: 99%

Infection Rates in Singaporeans with and without Complicated Diabetes after Ankle Fracture Surgery

Tan

Kwek

2015

J Orthop Surg (Hong Kong)

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Purpose.To compare infection rates in Singaporeans with and without complicated diabetes after ankle fracture surgery. Methods. Medical records of 18 men and 27 women aged 38 to 84 (mean, 62) years with complicated (n=12) or uncomplicated (n=33) diabetes who underwent internal fixation for closed ankle fractures were reviewed. Complicated diabetes was defined as having end organ dysfunction. The control of diabetes was categorised as good (n=19), fair (n=10), and poor (n=16), based on HbA1c level within 4 months before or after surgery. Patients were followed up at weeks 2, 6, 12, and 24, with bone union as the end point. Results. The mean follow-up period was 9 (range, 4-12) months. 2 (6%) of 33 patients with uncomplicated diabetes and 6 (50%) of 12 patients with complicated diabetes developed superficial or deep infection. No patient died or underwent amputation secondary to infection. In multivariable logistic regression analysis after adjusting for co-morbidities, only complicated

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“…(3) Both diseases are detrimental to the bone resulting in an increased risk for fragility fractures (4) : the lifetime risk to sustain an osteoporotic fracture ranges between 40% to 50% in women (5) and in T2D, the risk of having a fragility fracture lies even higher and varies dependent on the skeletal site between 20% and 160% in elderly women. (6) Given the substantial morbidity, mortality, and costs that emanate from osteoporotic (7) or T2D-related fractures, (8,9) proper recognition of populations at increased fracture risk is indispensable. Areal bone mineral density (aBMD) testing by dual energy X-ray absorptiometry (DXA) and assessment of clinical scores such as the WHO Fracture Risk Assessment Tool (FRAX) are regarded as the international standards for assessment of fracture risk in osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

Serum miRNA Signatures Are Indicative of Skeletal Fractures in Postmenopausal Women With and Without Type 2 Diabetes and Influence Osteogenic and Adipogenic Differentiation of Adipose Tissue–Derived Mesenchymal Stem Cells In Vitro

Heilmeier

Hackl²,

Skalicky

et al. 2016

Journal of Bone and Mineral Research

122

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Standard DXA measurements, including Fracture Risk Assessment Tool (FRAX) scores, have shown limitations in assessing fracture risk in Type 2 Diabetes (T2D), underscoring the need for novel biomarkers and suggesting that other pathomechanisms may drive diabetic bone fragility. MicroRNAs (miRNAs) are secreted into the circulation from cells of various tissues proportional to local disease severity and were recently found to be crucial to bone homeostasis and T2D. Here, we studied, if and which circulating miRNAs or combinations of miRNAs can discriminate best fracture status in a well-characterized study of diabetic bone disease and postmenopausal osteoporosis (n ¼ 80 postmenopausal women). We then tested the most discriminative and most frequent miRNAs in vitro. Using miRNA-qPCR-arrays, we showed that 48 miRNAs can differentiate fracture status in T2D women and that several combinations of four miRNAs can discriminate diabetes-related fractures with high specificity and sensitivity (area under the receiver-operating characteristic curve values [AUCs], 0.92 to 0.96; 95% CI, 0.88 to 0.98). For the osteoporotic study arm, 23 miRNAs were fracture-indicative and potential combinations of four miRNAs showed AUCs from 0.97 to 1.00 (95% CI, 0.93 to 1.00). Because a role in bone homeostasis for those miRNAs that were most discriminative and most present among all miRNA combinations had not been described, we performed in vitro functional studies in human adipose tissue-derived mesenchymal stem cells to investigate the effect of miR-550a-5p, miR-188-3p, and miR-382-3p on osteogenesis, adipogenesis, and cell proliferation. We found that miR-382-3p significantly enhanced osteogenic differentiation (p < 0.001), whereas miR-550a-5p inhibited this process (p < 0.001). Both miRNAs, miR-382-3p and miR-550a-5p, impaired adipogenic differentiation, whereas miR-188-3p did not exert an effect on adipogenesis. None of the miRNAs affected significantly cell proliferation. Our data suggest for the first time that miRNAs are linked to fragility fractures in T2D postmenopausal women and should be further investigated for their diagnostic potential and their detailed function in diabetic bone.

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The Impact of Diabetes on Patient Outcomes After Ankle Fracture

Cited by 27 publications

References 10 publications

Complications in ankle fracture surgery

Complications in ankle fracture surgery

Infection Rates in Singaporeans with and without Complicated Diabetes after Ankle Fracture Surgery

Serum miRNA Signatures Are Indicative of Skeletal Fractures in Postmenopausal Women With and Without Type 2 Diabetes and Influence Osteogenic and Adipogenic Differentiation of Adipose Tissue–Derived Mesenchymal Stem Cells In Vitro

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