Outcomes of open or closed treatment of foot fractures: A database study comparing patients with and without diabetes

Treatment of ankle and foot fractures in patients with diabetes mellitus (DM) is challenging, and complications may arise. Although much data exists on complication rates in tibial, fibular, and malleolar fractures, there exists a comparable lack of data on complication rates in fractures of the tarsal, metatarsal, and phalanx bones of the foot. Therefore, we aimed to compare post-procedural outcomes after such fractures in diabetic vs non-diabetic patients. A commercially available de-identified database was searched using ICD-10 codes for the open or closed surgical treatment in patients with fractures of the calcaneus, cuboid, navicular, talus, cuneiforms, metatarsals, and phalanges from 2010 to 2023. Patients with at least 1 year of post-procedural follow-up were included. We then separated patients into two groups: those with diabetes (108,603, 26.4 %) and those without diabetes (302,464, 73.6 %). Post-procedural complications assessed including those related to hardware when surgical treatment was pursued (reoperation, non-union, malunion, delayed union, wound disruption, surgical site infection) and health complications after fracture treatment (AKI, DVT, MI, pneumonia, sepsis) were assessed at 1 year and odds ratios were used to compare rates of these complications in diabetics vs non-diabetics for each bone. Rates of complications after fracture treatment were found to be significantly higher in all bones for diabetic patients compared to non-diabetic patients.