Morbidity after femoral neck fracture not increased in diabetics

Hjortrup, A; Sørensen, Christina; Dyremose, E; Kehlet, Henrik

doi:10.3109/17453678508993021

Cited by 4 publications

(1 citation statement)

References 5 publications

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“…13 However, diabetes does not appear to be a risk factor for postoperative wound complications in major surgery. [14][15][16] Moreover, diabetic patients with postoperative complications were found to have significantly lower blood glucose levels, ie, closer to normoglycemia preoperatively and postoperatively, than those without complications. 17 Finally, collagen accumulation in acute wounds in men with well-controlled type 1 diabetes was similar to that of nondiabetic subjects.…”

Section: Resultsmentioning

confidence: 99%

Decrease of Collagen Deposition in Wound Repair in Type 1 Diabetes Independent of Glycemic Control

Black¹

2003

Arch Surg

107

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Type 1 and type 2 diabetes mellitus and glycemic control influence wound healing in humans.Design: Experimental study using a human woundhealing model.Setting: Collaboration among a multidisciplinary woundhealing department, department of medicine, and research laboratories.Patients, Control Subjects, and Methods: In 34 patients with type 1 (insulin-dependent) and 25 with type 2 (non-insulin-dependent) diabetes and 5 nondiabetic control subjects matched with the type 2 diabetic patients, wound-healing capacity was determined as subcutaneous accumulation of collagen measured as hydroxyproline. Two expanded polytetrafluoroethylene tubes were implanted and removed 10 days later. The hydroxyproline level was determined by means of high-performance liquid chromatography; the collagenase activity, by using a radiolabeled collagen substrate. Proliferation of fibroblasts cultured from the wounds was studied in patient groups. Results:The deposition of hydroxyproline decreased by 40% (P=.03) in type 1 compared with type 2 diabetes (median, 0.70 vs 1.16 nmol/mg; interquartile range, 0.48-1.04 vs 0.56-1.63 nmol/mg), which in turn did not differ significantly from that of controls (median, 1.35 nmol/ mg; interquartile range, 0.72-1.88 nmol/mg). The decreased collagen deposition in type 1 diabetes was not caused by increased collagenase activity. The deposition of hydroxyproline did not correlate significantly (r s =0.07; P=.63) with glycosylated hemoglobin levels in either diabetic group. Fibroblast growth was also decreased in type 1 compared with type 2 diabetic patients and controls.Conclusions: Collagen deposition in acute wounds is impaired in type 1 diabetes, possibly due to a decreased fibroblast proliferation. In type 2 diabetes, collagen deposition is normal. Glycemic control does not influence collagen deposition in acute wound repair in type 1 or in type 2 diabetes mellitus.

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