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Outcomes of Ankle Fractures in Patients with Uncomplicated Versus Complicated Diabetes

UPMC Comprehensive Foot and Ankle Center, Orthopaedic, 2100 Jane St., Pittsburgh, PA 15203, USA.
Foot & Ankle International (Impact Factor: 1.63). 02/2011; 32(2):120-30. DOI: 10.3113/FAI.2011.0120
Source: PubMed

ABSTRACT Patients with diabetes who sustain an ankle fracture are at increased risk for complications including higher rates of in hospital mortality, in-hospital postoperative complications, length of stay and non-routine discharges. The purpose of this study was to retrospectively compare the complications associated with operatively treated ankle fractures in a group of patients with uncomplicated diabetes versus a group of patients with complicated diabetes. Complicated diabetes was defined as diabetes associated with end organ damage such as peripheral neuropathy, nephropathy and/or PAD. Uncomplicated diabetes was defined as diabetes without any of these associated conditions. Our hypothesis was that patients with uncomplicated diabetes would experience fewer complications than those patients with complicated diabetes.
We compared the complication rates of ankle fracture repair in 46 patients with complicated diabetes and 59 patients with uncomplicated diabetes and calculated odds ratios (OR) for significant findings.
At a mean followup of 21.4 months we found that patients with complicated diabetes had 3.8 times increased risk of overall complications 3.4 times increased risk of a non-infectious complication (malunion, nonunion or Charcot arthropathy) and 5 times higher likelihood of needing revision surgery/arthrodesis when compared to patients with uncomplicated diabetes. Open ankle fractures in this diabetic population were associated with a three times higher rate of complications and 3.7 times higher rate of infection.
Patients with complicated diabetes have an increased risk of complications after ankle fracture surgery compared to patients with uncomplicated diabetes. Careful preoperative evaluation of the neurovascular status is mandatory, since many patients with diabetes do not recognize that they have neuropathy and/or peripheral artery disease.

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    • "Patients with diabetes have higher complication rates for both open and closed management of ankle fractures (McCormack and Leith 1998, Wukich and Kline 2008, Hak et al. 2011). Wound complication rates as high as 32% and 64% have been reported in diabetic patients following ORIF of closed (Flynn et al. 2000, Jones et al 2005, Wukich et al. 2011) and open (Blotter et al. 1999, White et al. 2003) ankle fractures, respectively. However , there is good evidence that operative management of an unstable ankle fracture in a diabetic patient is more likely to result in a stable and functional lower extremity compared to nonoperative treatment (Bibbo et al 2001, Wukich and Kline 2008). "
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