Primary Arthrodesis for Diabetic Ankle Fractures

Area of Science:

• Orthopedic surgery
• Diabetic foot complications
• Traumatology

Background:

• Ankle fractures in diabetic patients have higher complication rates.
• Ankle arthrodesis is typically a salvage procedure, but primary arthrodesis is being considered for diabetic patients with severe complications.
• Characteristics and outcomes of primary ankle arthrodesis in this population are not well-described.

Purpose of the Study:

• To characterize patients undergoing primary ankle arthrodesis for traumatic ankle fractures.
• To describe the outcomes and complication rates associated with primary ankle arthrodesis in diabetic patients.

Main Methods:

• Retrospective review of 13 diabetic patients who underwent primary ankle arthrodesis for traumatic ankle fractures.
• Assessment of patient demographics, diabetes complications, Adelaide Fracture in the Diabetic Ankle (AFDA) scores, and fracture types.
• Evaluation of reoperation, infection, wound complications, nonunion/malunion, amputation, and Charcot arthropathy rates.

Main Results:

• Patients had high rates of diabetes complications (average AFDA score 6.4) and severe injuries (38.5% open fractures, 69.2% fracture dislocations).
• Overall complication rate exceeded 75%, with 38.5% reoperation, 38.5% infection, 53.8% wound complications, and 23.1% amputation.
• Despite high nonunion rates, 89.9% of fractures healed, resulting in a stable extremity.

Conclusions:

• This is the first study to characterize the epidemiology and complications of primary ankle arthrodesis for ankle fractures in diabetic patients.
• Primary ankle arthrodesis in this cohort, comprising patients with multiple diabetic complications and severe injuries, resulted in a high overall complication rate.
• Further research is needed to identify optimal treatments, with tibiotalocalcaneal stabilization without arthrodesis suggested as a potential alternative.