Effect of the Blood HbA1c Level on Surgical Treatment Outcomes of Diabetics with Ankle Fractures

Abstract

Blood HbA1c levels appear to be predictive of risk and complication rates in the surgical treatment outcomes of diabetic patients with ankle fractures.

Preoperative Glycosylated Hemoglobin and Postoperative Glucose Together Predict Major Complications after Abdominal Surgery

“…Liu et al found that HbA1c > 6.5% was associated with increased rates of poor radiological outcomes, revisions, and complications in ankle surgery. (10) M A N U S C R I P T…”

“…(9,10,(19)(20)(21)(22) However, it is unclear if the findings in cardiac and orthopedic surgery patients are generalizable to general surgery patients undergoing intraabdominal procedures. A recent single-institution study reported an association between HbA1c greater than 8% and increased length of stay.…”

“…(5,6) Poor long-term glycemic control, as measured by HbA1c, has also been associated with increased postoperative complications. (7)(8)(9)(10)(11) The last published guidelines from the Centers for Disease Control are from 1999 and recommend that practitioners "adequately control serum blood glucose levels in all diabetic patients and particularly avoid hyperglycemia perioperatively." (12) Since the publication of these guidelines, the definition of hyperglycemia has changed with publication of several influential randomized trials of intensive insulin therapy in critically ill patients.…”

Expert Opinion: Diabetic Ankle Fracture

“…The most significant complication in diabetic patients with ankle fractures is the risk of superficial and deep wound infections. In diabetic patients with ankle fractures, elevated HbA1C levels greater than 6.5% appear to be predictive of higher complication rates in those receiving surgical treatment [1]. This also establishes the importance of tight blood glucose control preoperatively and postoperatively.…”

“…If syndesmosis injuries are present, percutaneous methods may also be used for fixation. Again, this allows for the least amount of incision with the greatest amount of stability [1].…”