Heilungsdauer von Fuß- und Knöchelfrakturen bei Diabetikern: Literaturübersicht und Darstellung eigener Fälle

Boddenberg, U

doi:10.1055/s-2004-832398

Cited by 23 publications

(4 citation statements)

References 20 publications

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“…The latter could not be confirmed in the present study. Boddenberg [4] concluded that ankle fractures in patients with diabetes heal with a significant delay. In a study of Egol et al [11], younger age, male gender, and absence of diabetes were predictive of improved functional recovery at 1 year following ankle fracture surgery.…”

Section: Discussionmentioning

confidence: 99%

Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures

Weert

Lieshout

Vries

et al. 2011

Arch Orthop Trauma Surg

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IntroductionTreatment of ankle fractures is often based on fracture type and surgeon’s individual judgment. Literature concerning the treatment options and outcome are dated and frequently contradicting. The aim of this study was to determine the clinical and functional outcome after AO-Weber B-type ankle fractures in operatively and conservatively treated patients and to determine which factors influenced outcome.Patients and methodsA retrospective cohort study in patients with a AO-Weber B-type ankle fracture. Patient, fracture and treatment characteristics were recorded. Clinical and functional outcome was measured using the Olerud–Molander Ankle Score (OMAS), the American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS) and a Visual Analog Score (VAS) for overall satisfaction (range 0–10).ResultsEighty-two patients were treated conservatively and 103 underwent operative treatment. The majority was female. Most conservatively treated fractures were AO-Weber B1.1 type fractures. Fractures with fibular displacement (mainly AO type B1.2 and Lauge-Hansen type SER-4) were predominantly treated operatively. The outcome scores in the non-operative group were OMAS 93, AOFAS 98, and VAS 8. Outcome in this group was independently negatively affected by age, affected side, BMI, fibular displacement, and duration of plaster immobilization. In the surgically treated group, the OMAS, AOFAS, and VAS scores were 90, 97, and 8, respectively, with outcome negatively influenced by duration of plaster immobilization.ConclusionTreatment selection based upon stability and surgeon’s judgment led to overall good clinical outcome in both treatment groups. Reducing the cast immobilization period may further improve outcome.

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Section: Discussionmentioning

confidence: 99%

Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures

Weert

Lieshout

Vries

et al. 2011

Arch Orthop Trauma Surg

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“…Both clinical and experimental studies have shown that diabetes affects fracture healing ( 13 , 20 21 22 ). Diabetes affects the biomechanical properties of bone and results in decreased bone mechanical strength ( 23 ).…”

Section: Methodsmentioning

confidence: 99%

Diabetes mellitus affects the biomechanical function of the callus and the expression of TGF-beta1 and BMP2 in an early stage of fracture healing

Sun

Zhang

et al. 2016

Braz J Med Biol Res

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Transforming growth factor beta 1 (TGF-β1) and bone morphogenetic protein-2 (BMP-2) are important regulators of bone repair and regeneration. In this study, we examined whether TGF-β1 and BMP-2 expressions were delayed during bone healing in type 1 diabetes mellitus. Tibial fractures were created in 95 diabetic and 95 control adult male Wistar rats of 10 weeks of age. At 1, 2, 3, 4, and 5 weeks after fracture induction, five rats were sacrificed from each group. The expressions of TGF-β1 and BMP2 in the fractured tibias were measured by immunohistochemistry and quantitative reverse-transcription polymerase chain reaction, weekly for the first 5 weeks post-fracture. Mechanical parameters (bending rigidity, torsional rigidity, destruction torque) of the healing bones were also assessed at 3, 4, and 5 weeks post-fracture, after the rats were sacrificed. The bending rigidity, torsional rigidity and destruction torque of the two groups increased continuously during the healing process. The diabetes group had lower mean values for bending rigidity, torsional rigidity and destruction torque compared with the control group (P<0.05). TGF-β1 and BMP-2 expression were significantly lower (P<0.05) in the control group than in the diabetes group at postoperative weeks 1, 2, and 3. Peak levels of TGF-β1 and BMP-2 expression were delayed by 1 week in the diabetes group compared with the control group. Our results demonstrate that there was a delayed recovery in the biomechanical function of the fractured bones in diabetic rats. This delay may be associated with a delayed expression of the growth factors TGF-β1 and BMP-2.

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“…Es importante en estos casos un seguimiento cercano del paciente, ya que los pacientes diabéticos que han desarrollado complicaciones crónicas de la diabetes tienen una mayor predisposición a las complicaciones posquirúrgicas 24,27,28,33,34 . En este caso el paciente se mantuvo en descarga absoluta del pie intervenido durante 12 semanas para asegurar una consolidación ósea de manera efectiva y en la posición que se había conseguido en la cirugía, ya que conocemos estudios que muestran el retraso de consolidación ósea de estos pacientes comparados a pacientes sin diabetes [35][36][37][38] . La idea de fondo al tratar estos pacientes es prácticamente "doblar" todos los aspectos de la cirugía con respecto a un paciente no diabético para protegerlo lo más posible, por lo que se utiliza más material de osteosíntesis y se inmoviliza durante más tiempo.…”

Section: Discussionunclassified

Reconstrucción quirúrgica de un caso clínico complejo de neuroartropatía de Charcot

Pérez¹,

Cicchinelli²,

Huerta³

et al. 2020

Rev. Esp. Pod.

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La neuroartropatía de Charcot es reconocida como una enfermedad destructiva, progresiva y no infecciosa de origen multifactorial en pacientes con diabetes mellitus como principal causa etiológica. Esta destrucción puede ser a diferentes niveles del pie. El presente artículo presenta un caso clínico de un paciente que sufre una deformidad severa rígida en pie varo secundario a neuroartropatía de Charcot tipo II (según clasificación Sanders & Frykberg) en fase 2 (según clasificación de Eichenholtz) cuya solución de tratamiento propuesto era amputación infracondílea. Se realizó una reconstrucción quirúrgica de la deformidad consistente en alargamiento percutáneo del tendón de Aquiles, tenotomía del tibial posterior, fusión de la columna interna y externa con estabilización mediante placas de bloqueo; también se realizó fusión de la articulación subastragalina y trasposición del extensor común de los dedos y tibial anterior a la base del cuarto metatarsiano. El resultado del caso fue muy bueno y la evolución al año permitió al paciente incorporarse a su actividad diaria. Este artículo pretende mostrar una opción de tratamiento para este tipo de patología con buenos resultados y mostrando una posibilidad de solución a estos pacientes, evitando así la amputación del miembro.

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Heilungsdauer von Fuß- und Knöchelfrakturen bei Diabetikern: Literaturübersicht und Darstellung eigener Fälle

Cited by 23 publications

References 20 publications

Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures

Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures

Diabetes mellitus affects the biomechanical function of the callus and the expression of TGF-beta1 and BMP2 in an early stage of fracture healing

Reconstrucción quirúrgica de un caso clínico complejo de neuroartropatía de Charcot

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