Primary Arthrodesis for Diabetic Ankle Fractures

Abstract

Background: Treatment of ankle fractures in patients with diabetes is associated with increased complication rates. Ankle arthrodesis is considered a salvage procedure after failed ankle fracture fixation, yet primary ankle arthrodesis has been proposed as a treatment option for patients with significant diabetes-related complications. To date, the characteristics of patients who undergo primary ankle arthrodesis and the associated outcomes have not been described. Methods: A retrospective review was performed of 13 patients with diabetes who underwent primary arthrodesis for traumatic ankle fracture. Patient demographics were characterized in addition to their diabetes complications, Adelaide Fracture in the Diabetic Ankle (AFDA) score, and fracture type. Outcomes assessed included reoperation rates, infection rates, wound complications, nonunion/malunion, amputation, and development of Charcot arthropathy postoperatively. Results: Patients who underwent primary arthrodesis had high rates of diabetes complications, average AFDA scores of 6.4, and high rates of severe injuries, including 38.5% open fractures and 69.2% fracture dislocations. The overall complication rate for primary arthrodesis of ankle fractures in diabetes patients was more than 75% in this cohort. Complications included a 38.5% reoperation rate, 38.5% infection rate, 53.8% wound complication rate, and 23.1% amputation rate. Despite a high nonunion rate at the attempted fusion sites, 89.9% of fractures healed and patients had a stable extremity. Conclusion: This review is the first to characterize the epidemiology and complications of diabetes patients undergoing primary ankle arthrodesis for ankle fractures. In this cohort, patients with multiple diabetic complications and severe injuries underwent primary arthrodesis, which led to an overall high complication rate. Further research is needed to determine the appropriate treatment option for these high-risk patients, and tibiotalocalcaneal stabilization without arthrodesis may be beneficial. Level of Evidence: Level IV, retrospective case series.

Expanding Indications of Primary Arthrodesis in Selected Individuals for Managing Complex Hindfoot Trauma During COVID-19 Pandemic

“…Ankle arthrodesis is considered a salvage operation for failed as well as neglected ankle fracture [21,22]. Classic indications of ankle fusion in ankle fractures are diabetics with uncontrolled diabetes with a high risk of developing charcot arthropathy as well as patients with neglected fractures of the ankle with non-reconstructable malleoli or malunited ankle fractures in low-demand individuals as well as in patients with failed internal fixation of ankle fractures [23][24][25]. The authors expanded on these indications and performed ankle fusion in patients who presented late (over 12 weeks) or had undergone failed ankle fracture fixation.…”

Ankle Fractures in Diabetic Patients

“…Grote et al retrospectively reviewed 13 patients with diabetes who underwent primary TTC arthrodesis for unstable ankle fractures with formal preparation of the tibiotalar joint (Level IV evidence) 66 . They noted a high overall complication rate with 10/13 (76.9%) of experiencing at least 1 complication and 5/13 (38.5%) requiring operative debridement for infection.…”

Diagnosis and Treatment of Neuropathic Ankle Fractures

“…Grote et al 49 reported a case series of 13 diabetic patients with unstable ankle fractures that underwent primary arthrodesis of the tibiotalar joint. Eighty-two percent of the patients had peripheral neuropathy.…”