Ankle fractures in diabetic patients

Area of Science:

• Orthopedic surgery
• Diabetology

Background:

• Complicated diabetes mellitus significantly increases surgical complication rates.
• Approximately 13% of patients undergoing ankle fracture fixation have diabetes, with 2% having complicated diabetes.
• Non-operative management of ankle fractures in this population leads to even higher complication rates.

Purpose of the Study:

• To review the management of ankle fractures in patients with complicated diabetes.
• To highlight the risks of Charcot neuroarthropathy and limb loss.
• To recommend optimal surgical strategies for improved outcomes.

Main Methods:

• Literature review focusing on ankle fracture management in diabetic patients.
• Analysis of complication rates associated with operative and non-operative treatments.
• Evaluation of salvage procedures like hindfoot arthrodesis.

Main Results:

• Insufficient ankle fracture stability can precipitate Charcot neuroarthropathy, leading to bone loss, deformity, ulceration, and amputation.
• Rigid fixation is crucial for managing ankle fractures in diabetic patients.
• Hindfoot arthrodesis can salvage the limb in approximately 80% of cases, even after failed initial management.

Conclusions:

• Rigid fixation of ankle fractures is recommended for patients with complicated diabetes.
• Early protected weight-bearing is feasible with achieved rigid fixation and absence of deformity.
• Hindfoot arthrodesis serves as an effective limb salvage option.