Ankle fractures in diabetic patients

Gougoulias, Nikolaos; Oshba, Hesham; Dimitroulias, Apostolos; Sakellariou, Anthony; Wee, Alexander

doi:10.1302/2058-5241.5.200025

Cited by 26 publications

(17 citation statements)

References 25 publications

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“…Principles from Charcot foot reconstruction including rigid locking constructs and prolonged immobilization have been adapted to ankle fractures in diabetic patients. 23 In revision cases, arthrodesis serves as a salvage procedure to enable ambulation. 42 , 43 Second, strict glycemic control should be maintained in the postoperative setting.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Kidney Disease Is Associated With Increased Complications Following Operative Management of Ankle Fractures

Polachek

Baker

Dahm

et al. 2022

Foot & Ankle Orthopaedics

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Background: Diabetes mellitus and peripheral neuropathy are established risk factors for complications in operatively treated ankle fractures. Generally, the presence of peripheral neuropathy and diabetic nephropathy have been used as independent variables in studies of diabetic ankle fracture cohorts but are typically treated as binary risk factors. Our purpose was to quantify the effects of risk factors on complication rate specific to diabetic patients undergoing ankle fracture fixation. Methods: We identified 617 rotational ankle fractures treated operatively at a single academic medical center from 2010 to 2019, of which 160 were identified as diabetic. Of these, 91 ankle fractures in 90 diabetic patients met criteria for retrospective review of clinical and radiographic data. Criteria included perioperative laboratory studies, including glycated hemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR), as well as follow-up radiographs in the electronic record. We defined complications in this surgical cohort as deep surgical site infection, unplanned return to the operating room, and failure of fixation. Logistic regression was performed and odds ratios (ORs) calculated. Results: The overall complication rate was 28.6% (26/91) in this cohort. Median follow-up was 29 weeks (range: 5-520 weeks). Mean perioperative HbA1c in patients who experienced postoperative complications was 7.6% (range: 5.1%-14.2%) compared with 7.8% (range: 5.6%-13.5%) who did not ( P = .69). Diabetic patients with chronic kidney disease (eGFR <60 mL/min per body surface area) (OR 5.29, P = .006) and peripheral neuropathy (OR 4.61, P = .003) were at significantly higher risk of all complications compared with diabetic patients without these comorbidities. Of note, we did not find an association between perioperative HbA1c or body mass index and complication rate. Conclusion: Patients with diabetes complicated by chronic kidney disease are at significantly higher risk of complications following operative management of ankle fractures. Our study also corroborated previous reports that within this high-risk cohort, the presence of peripheral neuropathy is a significant risk factor for complications. These sequalae of diabetic disease are manifestations of microvascular disease, glycosylation of soft tissues, and impaired metabolic pathways. Identifying these risk factors in diabetic patients allows for patient-specific risk stratification, education, and management decisions of ankle fractures. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Diabetic Kidney Disease Is Associated With Increased Complications Following Operative Management of Ankle Fractures

Polachek

Baker

Dahm

et al. 2022

Foot & Ankle Orthopaedics

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“…Surgical strategies wherein the extent of soft tissue disruption is minimized is preferable in these complex patient scenarios 3 , with less invasive techniques such as TTCA identified as alternatives in high risk patients when definitively treating trimalleolar ankle fractures 1 . Despite TTCA often being described as an option in the degenerative setting with compromised soft tissues 5 , it has also been proposed as a viable primary treatment strategy for management of ankle fractures in a complex diabetic population, with the utilization of percutaneous or small incisions helping to reduce the overall infection and soft tissue complication risk in patients who often present with concurrent soft tissue diabetic sequelae 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Owing to the potentially significant risks associated with comorbid patients with underlying soft tissue compromise, selection of an appropriate and efficient treatment modality management minimizing the extent of soft-tissue disruption required is of benefit in maximizing outcomes in this potentially fragile population group 3 . Primary arthrodesis procedures have been shown to be a valid option in those with comminuted fractures, osteoporotic bone or underlying comorbidities such as diabetes 1,4 , with the utility of retrograde tibiotalocalcaneal nail arthrodesis (TTCA) through small incisions described as of particular benefit in minimizing soft tissue risk in primary treatment of ankle fractures in a diabetic population 4 . Arthroscopic techniques have also been increasingly reported as a useful adjunct in management of acute ankle fractures as well as in planned TTCA for osteoarthritis so to reduce insult to surrounding soft tissue and vascular supply 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic-assisted tibiotalocalcaneal arthrodesis in an ankle fracture with a suboptimal soft tissue envelope

Mohan

Davey

Power

et al. 2022

Foot & Ankle Surgery: Techniques, Reports & Cases

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…The case also highlights a successful fusion outcome in a procedure known to be technically difficult and fraught with risks such as infection and non-union. Recent literature reports high complication rates in both diabetic ankle fractures and TTC nails, with one review of diabetic ankle fractures reporting an overall complication rate of 47%, and another retrospective review reporting a non-union rate of 22.8% after subtalar arthrodesis via TTC nail [9,19].…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…In 2021, a meta-analysis of open ankle arthrodesis reported an overall complication rate of 14% for this procedure [8]. In diabetic ankle fractures the reported complication rate is much higher, with one review reporting a complication rate of 47% [9]. One important challenge of arthrodesis in diabetic patients is identifying the most scientifically advanced bone graft for the procedure [10].…”

Section: Introductionmentioning

confidence: 99%

Clinical, Radiographic, and Histologic Outcomes of Ankle Arthrodesis in a Diabetic Patient using a Biphasic Calcium Phosphate Bone Graft with a Novel Submicron Needle-shaped Surface Topography

Fusco¹

2022

JOJCS

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Patients with diabetes mellitus who sustain ankle fractures are at increased risk of complications including non-union, malunion, wound dehiscence, soft tissue infection, osteomyelitis, deterioration to Charcot arthropathy, and amputation [1][2][3]. Multiple publications have evaluated treatment options for diabetic patients with ankle fractures; management options include non-surgical treatment and immobilization, open reduction internal fixation, arthrodesis of the tibiotalar joint, arthrodesis of the tibiotalocalcaneal joints, external fixation, and amputation [4][5][6][7]. It is important to identify an effective bone graft for these cases, as well as to understand the science behind the bone graft selected. In recent years, the study of osteoimmunology has confirmed the reciprocal interaction of bone forming mesenchymal stem cells and immune cells on bone growth. This report describes an adult female patient with a late presenting ankle fracture dislocation, initially treated with ankle arthrodesis using a novel bone graft with submicron needle-shaped surface topography. The patient developed Charcot arthropathy and was revised to a tibiotalocalcaneal (TTC) nail. During revision, a biopsy was taken of a solidly fused segment and sent for histology. Radiographic, clinical, and histological data were tracked and showed solid fusion at 6 weeks radiographically, which was confirmed via histology and surgical exploration at 12 weeks, indicating notable results in this challenging arthrodesis case using a novel bone graft with submicron needle-shaped surface topography.

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Ankle fractures in diabetic patients

Cited by 26 publications

References 25 publications

Diabetic Kidney Disease Is Associated With Increased Complications Following Operative Management of Ankle Fractures

Diabetic Kidney Disease Is Associated With Increased Complications Following Operative Management of Ankle Fractures

Arthroscopic-assisted tibiotalocalcaneal arthrodesis in an ankle fracture with a suboptimal soft tissue envelope

Clinical, Radiographic, and Histologic Outcomes of Ankle Arthrodesis in a Diabetic Patient using a Biphasic Calcium Phosphate Bone Graft with a Novel Submicron Needle-shaped Surface Topography

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