Early Protected Weightbearing After Ankle Fractures in Patients With Diabetes Mellitus

Bazarov, Irina; Peace, Ruth A.; Lagaay, Pieter M.; Patel, Sandeep; Lyon, Liisa; Schuberth, John M.

doi:10.1053/j.jfas.2016.09.010

Cited by 18 publications

(8 citation statements)

References 21 publications

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“…Simply put eradication of infection with maintenance of internal fixation or conversion to secondary fusion appears to offer best solution for limb salvage. 32 As this review has demonstrated this cohort of patients have a high risk of complication and failure of treatment. With this in mind, along with the inherent increased cost, patients with secondary complications are likely to be more efficiently managed in the tertiary setting within a multidisciplinary diabetic foot clinical team 41 where there is a good volume of evidence for surgical correction for Charcot (not just related to failed ankle ORIF).…”

Section: Discussionmentioning

confidence: 86%

“…Bazarov et al 32 looked at their local hospital dataset of 78 patients with a diagnosis of diabetes who sustained an ankle fracture treated either operatively or non-operatively and had been selected to begin early weight bearing within 2 weeks in a non-removable cast by the treating surgeon. While their complication rates were low, they acknowledge thier patient cohort had a low comorbid profile.…”

Section: Early Weight-bearingmentioning

confidence: 99%

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Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

Nash¹,

Hester

2021

Journal of Clinical Orthopaedics and Trauma

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Background: Ankle fractures in diabetic patients are known to have an increased morbidity. This systematic review aims to evaluate the current evidence in terms of risk profile and inform treatment options. Methods: Following the methodology of the Cochrane collaboration, an extensive literature search was conducted. Outcomes included, complications, operative and non-operative management and early weight-bearing. Results: A total of 40 studies were included. Complication rates were higher in diabetic patients and more so in poorly controlled diabetes, IDDM, or "complicated" diabetes. Supplementary fixation was associated with lower complication rates. Regarding early weight-bearing, similar results to nondiabetics in the stable fracture pattern were found providing there was no evidence of neuropathy. Conclusion: Diabetes, especially complicated diabetes, presents an increased risk of complications. However non operative management of diabetic ankle fractures do poorly, and with the use of 'ORIF plus' techniques there is no increase in complications from early fixation. The use of external fixation for definitive fixation should be minimised as it is associated with high complication rates.

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Section: Discussionmentioning

confidence: 86%

Section: Early Weight-bearingmentioning

confidence: 99%

Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

Nash¹,

Hester

2021

Journal of Clinical Orthopaedics and Trauma

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“… 8 A study in the diabetic ankle fracture population with early protected weightbearing at two weeks post open reduction internal fixation recorded a complication rate of 25%. 2 The insensate foot, much like other neuropathies, such as diabetic neuropathy, predisposes this cohort to high risk of skin breakdown, malunion, failure of hardware and possible amputation. 4 Delaying ankle fracture surgery had a 12.9% of wound complications versus 3.6% in the expedited group in a systematic review.…”

Section: Discussionmentioning

confidence: 99%

Ankle Fracture in Hereditary Sensory Neuropathy Type 1

Loh¹,

Cyr²,

Martin

2021

The Journal of Foot and Ankle Surgery

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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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“…However, the latter has not been supported by strong scientific evidence and some publications are challenging the above ‘concept’, advocating early protected weight bearing in cast or boot, two weeks after surgery. 23 , 24 …”

Section: Postoperative Rehabilitationmentioning

confidence: 99%

Ankle fractures in diabetic patients

et al. 2020

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Surgical complications are more common in patients with complicated diabetes (presence of inner organ failure, neuropathy). Of all patients undergoing ankle fracture fixation, approximately 13% are diabetic and 2% have complicated diabetes mellitus. Non-operative management of ankle fractures in patients with complicated diabetes results in an even higher rate of complications. Insufficient stability of ankle fractures (treated operatively, or non-operatively) can trigger Charcot neuroarthropathy, and result in bone loss, deformity, ulceration, and the need for amputation. Rigid fixation is recommended. Hindfoot arthrodesis (as primary procedure or after failed ankle fracture management) can salvage the limb in approximately 80% of patients. Early protected weight bearing can be allowed, provided rigid fixation without deformity has been achieved. Cite this article: EFORT Open Rev 2020;5:457-463. DOI: 10.1302/2058-5241.5.200025

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Early Protected Weightbearing After Ankle Fractures in Patients With Diabetes Mellitus

Cited by 18 publications

References 21 publications

Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

Ankle Fracture in Hereditary Sensory Neuropathy Type 1

Ankle fractures in diabetic patients

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