Minimal Invasive Fixation Can Decrease Infection Rates in Diabetic and Obese Patients With Severe Ankle Fracture and Syndesmotic Injury

Ebraheim, Nabil A.; Dailey, Matthew N.; Huff, Scott; Qu, Yihuai; White, Erik; Liu, Jiayong

doi:10.1177/1938640018766627

Cited by 8 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, with the increased awareness of the tenuous soft tissue envelope and the lack of adequate biology at times, recent authors have advocated for alternative fixation methods to help increase rates of limb salvage. Minimally invasive approaches including percutaneous cannulated screws 12,13 or Minimally Invasive Plate Osteosynthesis (MIPO) 14 have been described as techniques to avoid large surgical incisions and maintain periosteal blood supply. Likewise, the use of intramedullary fixation including locked fibular nailing or tibiotalocalcaneal (TTC) nailing also utilizes smaller incisions and can preserve the soft tissue envelope.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of ankle fracture treatment modalities in diabetic patients

Manchanda¹,

Nakonezny

Sathy

et al. 2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

Aim: This systematic review evaluated the surgical outcomes of various ankle fracture treatment modalities in patients with Diabetes Mellitus as well as the methodological quality of the studies. Methods: For our review, four online databases were searched: PubMed, MEDLINE (Clarivate Analytics), CINAHL (Cumulative Index to Nursing and Allied Health) and Web of Science (Clarivate Analytics). The overall methodological quality of the studies was assessed with the Coleman Methodology Score. Data regarding diabetic ankle fractures were pooled into three outcomes groups for comparison: (1) the standard fixation cohort with management of diabetic ankle fractures using ORIF with small or mini fragment internal fixation techniques following AO principles, (2) the minimally invasive cohort with diabetic ankle fracture management utilizing percutaneous cannulated screws or intramedullary fixation, and (3) the combined construct cohort treated with a combination of ORIF and another construct (transarticular or external fixation). Results: The search strategy identified 2228 potential studies from the four databases and 11 were included in the final review. Compared to the standard fixation cohort, the minimally invasive cohort had increased risk of hardware breakage or migration and the combined constructs cohort had increased risk of hardware breakage or migration, surgical site infection and nonunion. Limb salvage rates were similar for the standard fixation and minimally invasive cohorts; however, the combined constructs cohort had a significantly lower limb salvage rate compared to that of the standard fixation cohort. The mean Coleman Methodology Score indicated the quality of the studies in the review was poor and consistent with its limitations. Discussion: The overall quality of published studies on operative treatment of diabetic ankle fractures is low. Treating diabetic ankle fractures operatively results in a high number of complications regardless of fixation method. However, limb salvage rates remain high overall at 97.9% at a mean follow-up of 21.7 months. To achieve improved limb salvage rates and decrease complications, it is critical is to follow basic AO principles, respect the soft tissue envelope or utilize minimally invasive techniques, and be wary that certain combined constructs may be associated with higher complication rates. Level of evidence: 2.

show abstract

Section: Introductionmentioning

confidence: 99%

A systematic review of ankle fracture treatment modalities in diabetic patients

Manchanda¹,

Nakonezny

Sathy

et al. 2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

show abstract

“… 15 , 19 However, suture-button devices are associated with an increased risk of neurovascular bundle entrapment, infections caused by the fiber wire, and osteomyelitis. 18 Pain and irritation have been found similar in both static and dynamic procedures. The risks and benefits of different surgical approaches must be weighed while determining treatment.…”

Section: Treatment Of Syndesmosis Injurymentioning

confidence: 86%

“…Premature degradation of implants is believed to be responsible for malunion in nearly 26% of cases with high rates of osteolysis and sterile wound sinuses. 18 …”

Section: Treatment Of Syndesmosis Injurymentioning

confidence: 99%

“…Premature degradation of implants is believed to be responsible for malunion in nearly 26% of cases with high rates of osteolysis and sterile wound sinuses. 18 Intramedullary fibular nails are a static fixation option in the surgical repair of syndesmotic ankle injuries. Reaming of the nail canal is an invasive process after which the ankle requires immobilization and for the ankle to be held nonweight bearing before a second operation for removal.…”

Section: Treatment Of Syndesmosis Injurymentioning

confidence: 99%

See 1 more Smart Citation

Management of Syndesmosis Injury: A Narrative Review

Liu¹,

Valentine²,

Ebraheim³

2022

ORR

Self Cite

View full text Add to dashboard Cite

The syndesmosis is an important fibrous joint that plays a crucial role in normal ankle weight-bearing and movements. Syndesmosis injuries include disruption of one or more of the ligaments comprising the distal tibiofibular syndesmosis and are commonly associated with ankle fractures. The treatment of grade 1 syndesmosis injury should be conservative, such as immobilization for one to three weeks followed by gradual return to activity. For the treatment of grade 2 syndesmosis injury, if it was stable enough, the patients still could be managed with conservative therapies. But majority of them strongly favor surgical treatment. For the treatment of grade 3 syndesmosis injury, it should treat with surgical reconstruction. If syndesmosis injury is associated with ankle fractures, surgical reduction, fixation, and reconstruction are usually required. Common surgical treatment methods include syndesmosis screws, composed of either metallic or bioabsorbable material; fibula intramedullary nails; and dynamic button-suture fixation, TightRope or ZipTight. Each method has advantages and disadvantages which must be considered while determining which treatment will provide the best outcomes depending on the patient’s needs. Continued exploration of new materials, devices, and methods for surgical fixation is necessary for advancement in this field.

show abstract

“…Two small, retrospective studies found low complication rates of complications after percutaneous fixation of ankle fractures in diabetic patients. 12,13 However, a systemic review found that a cohort of diabetic patients with percutaneously treated ankle fractures had a higher rate of implant breakage or migration compared with those who underwent open treatment. 14 Although not definitive, our data suggest we should anticipate a high complication rate in the surgical treatment of these fractures, regardless of the method of fixation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of fracture surgery in patients with escalating hemoglobin A1C in the setting of unmanaged diabetes

Lawson

Stuart

Ramsey

et al. 2023

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

Objective: To determine whether there is a threshold of elevated hemoglobin A1C (HbA1c) above which the complication risk is so high that fracture fixation should be avoided. Design: Retrospective cohort study. Setting: Academic Level I trauma center. Patients/Participants: A cohort of 187 patients with HbA1c values >7 and operatively treated extremity fractures. Intervention: Surgical fixation of extremity fractures. Main Outcome Measurements: Rate of major orthopaedic complication (loss of reduction, nonunion, infection, and need for salvage procedure). Results: 34.8% demonstrated HbA1c > 9% and 12.3% with HbA1c > 11. Major complications occurred in 31.4%; HbA1c values were not predictive. We found no evidence of a clinically or statistically significant relationship between HbA1c and risk of major complication. The odds ratio for a one-point increase in HbA1c was 1.006 (P = 0.9439), and the area under the receiver operating characteristic curve, which reflects the average probability that someone with a major complication will have a higher HbA1c than someone without, was 0.51 (95% confidence interval 0.42–0.61), equivalent to random chance. Conclusion: Diabetic patients with fracture demonstrated an extremely high overall rate of complications, with 30.5% experiencing a major complication. However, patients with extreme diabetic neglect did not have higher complication rates after extremity fracture fixation when compared with patients with controlled and uncontrolled diabetes. There was no correlation between rate of complication and level of HbA1c. In addition, there was no difference in complication rate between upper and lower extremity fractures or between fractures treated with open or percutaneous fixation. This suggests that fracture treatment decision-making should not be altered for patients with poor diabetic control, and that surgery is not contraindicated in patients with an extremely high HbA1c. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Minimal Invasive Fixation Can Decrease Infection Rates in Diabetic and Obese Patients With Severe Ankle Fracture and Syndesmotic Injury

Abstract: Therapeutic, Level III: Retrospective comparative study.

Cited by 8 publications

References 19 publications

A systematic review of ankle fracture treatment modalities in diabetic patients

A systematic review of ankle fracture treatment modalities in diabetic patients

Management of Syndesmosis Injury: A Narrative Review

Outcomes of fracture surgery in patients with escalating hemoglobin A1C in the setting of unmanaged diabetes

Contact Info

Product

Resources

About