Ankle Fractures in Diabetic Patients: A Critical Analysis.
Journal
JBJS reviews
ISSN: 2329-9185
Titre abrégé: JBJS Rev
Pays: United States
ID NLM: 101674872
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
entrez:
17
3
2023
pubmed:
18
3
2023
medline:
21
3
2023
Statut:
epublish
Résumé
Patients with diabetes are at higher risk for complications after surgical fixation of unstable fractures due to impaired neurovascular functioning and wound-healing capabilities. Patients with uncontrolled diabetes have higher rates of complications when compared with patients with controlled diabetes. Despite higher rates of complications, operative fixation of unstable ankle fractures in diabetic patients reliably leads to a functional lower extremity with an overall lower rate of complications than nonoperative management. Operatively and nonoperatively managed ankle fractures in patients with diabetes should remain non-weight-bearing for an extended period of time. Discussion of risk of poor outcomes including deep infection, loss of reduction, return to the operating room, and risk of arthrodesis or amputation should be explicitly discussed with patients and families when managing unstable ankle fractures in diabetic patients.
Identifiants
pubmed: 36927706
doi: 10.2106/JBJS.RVW.22.00147
pii: 01874474-202303000-00003
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A923).
Références
Scheer RC, Newman JM, Zhou JJ, Oommen AJ, Naziri Q, Shah NV, Pascal SC, Penny GS, McKean JM, Tsai J, Uribe JA. Ankle fracture epidemiology in the United States: patient-related trends and mechanisms of injury. J Foot Ankle Surg. 2020;59(3):479-83.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691-7.
Juto H, Nilsson H, Morberg P. Epidemiology of adult ankle fractures: 1756 cases identified in Norrbotten County during 2009-2013 and classified according to AO/OTA. BMC Musculoskelet Disord. 2018;19(1):441.
Daly PJ, Fitzgerald RH, Melton LJ, Llstrup DM. Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand. 1987;58(5):539-44.
Prisk VR, Wukich DK. Ankle fractures in diabetics. Foot Ankle Clin. 2006;11(4):849-63.
Hansen R, Shibuya N, Jupiter DC. An updated epidemiology of foot and ankle fractures in the United States: complications, mechanisms, and risk factors. J Foot Ankle Surg. 2022;61(5):1034-8.
Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg. 2018;24(1):34-9.
Shibuya N, Davis ML, Jupiter DC. Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011). J Foot Ankle Surg. 2014;53(5):606-8.
Jensen SL, Andresen BK, Mencke S, Nielsen PT. Epidemiology of ankle fractures: a prospective population-based study of 212 cases in Aalborg, Denmark. Acta Orthop Scand. 1998;69(1):48-50.
Sanders DW, Tieszer C, Corbett B; Society on behalf of the COT. Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial. J Orthop Trauma. 2012;26(3):129-34.
Centers for Disease Control and Prevention; National Center for Health Statistics. Life Expectancy. 2021. Available at: https://www.cdc.gov/nchs/fastats/life-expectancy.htm . Accessed June 19, 2022.
US Census Bureau. 2017 National Population Projections Tables: Main Series. Census.gov. Available at: https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html . Accessed June 19, 2022.
Kannus P, Palvanen M, Niemi S, Parkkari J, Jrvinen M. Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970-2000 and projections for the future. Bone. 2002;31(3):430-3.
Antonio-Villa NE, Fernández-Chirino L, Vargas-Vázquez A, Fermín-Martínez CA, Aguilar-Salinas CA, Bello-Chavolla OY. Prevalence trends of diabetes subgroups in the United States: a data-driven analysis spanning three decades from NHANES (1988-2018). J Clin Endocrinol Metab. 2022;107(3):735-42.
Wukich DK, Kline AJ. The management of ankle fractures in patients with diabetes. J Bone Joint Surg Am. 2008;90(7):1570-8.
National Diabetes Statistics Report | Diabetes | CDC. 2022. Available at: https://www.cdc.gov/diabetes/data/statistics-report/index.html . Accessed June 19, 2022.
Ghotaslou R, Memar MY, Alizadeh N. Classification, microbiology and treatment of diabetic foot infections. J Wound Care. 2018;27(7):434-41.
Volmer-Thole M, Lobmann R. Neuropathy and diabetic foot syndrome. Int J Mol Sci. 2016;17(6):917.
Haddix KP, Clement RC, Tennant JN, Ostrum RF. Complications following operatively treated ankle fractures in insulin- and non–insulin-dependent diabetic patients. Foot Ankle Spec. 2018;11(3):206-16.
Liu JW, Ahn J, Nakonezny PA, Lalli T, VanPelt MD, Raspovic KM, Wukich DK, Liu GT. Insulin dependence increases the risk of 30-day postoperative complications following ankle fracture surgery in patients with diabetes mellitus. J Foot Ankle Surg. 2021;60(5):917-22.
Basques BA, Miller CP, Golinvaux NS, Bohl DD, Grauer JN. Morbidity and readmission after open reduction and internal fixation of ankle fractures are associated with preoperative patient characteristics. Clin Orthop Relat Res. 2015;473(3):1133-9.
Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, Brazg RL, Ilany J, Slover RH, Anderson SM, Bergenstal RM, Grosman B, Roy A, Cordero TL, Shin J, Lee SW, Kaufman FR. Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2017;19(3):155-63.
Lau S, Lee M. Hyperglycaemia is an under-appreciated but modifiable risk factor in managing people with type 1 diabetes and fragility fractures. Foot. 2019;40:43-5.
Liu J, Ludwig T, Ebraheim NA. Effect of the blood HbA1c level on surgical treatment outcomes of diabetics with ankle fractures. Orthop Surg. 2013;5(3):203-8.
Wukich DK, Joseph A, Ryan M, Ramirez C, Irrgang JJ. Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes. Foot Ankle Int. 2011;32(2):120-30.
Polachek WS, Baker HP, Dahm JS, Strelzow JA, Hynes KK. Diabetic kidney disease is associated with increased complications following operative management of ankle fractures. Foot Ankle Orthop. 2022;7(3):247301142211121.
Young MJ, Boulton AJM, Macleod AF, Williams DRR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36(2):150-4.
Kumar S, Ashe HA, Parnell LN, Fernando D, Tsigos C, Young R, Ward J, Boulton A. The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study. Diabet Med. 1994;11(5):480-4.
Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, Wilson DM, O'Brien PC, Melton LJ. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology. 1993;43(4):817-24.
Dyck PJ, Litchy WJ, Lehman KA, Hokanson JL, Low PA, O'Brien PC. Variables influencing neuropathic endpoints: the Rochester Diabetic Neuropathy Study of Healthy Subjects. Neurology. 1995;45(6):1115-21.
Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Pharmacol Ther. 2008;120(1):1-34.
Naemi R, Chockalingam N, Lutale JK, Abbas ZG. Predicting the risk of future diabetic foot ulcer occurrence: a prospective cohort study of patients with diabetes in Tanzania. BMJ Open Diabetes Res Care. 2020;8(1):e001122.
Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, Boulton AJ. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22(1):157-62.
Young MJ, Breddy JL, Veves A, Boulton AJM. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study. Diabetes Care. 1994;17(6):557-60.
Ziegler D, Keller J, Maier C, Pannek J. Diabetic neuropathy. Exp Clin Endocrinol Diabetes. 2014;122(7):406-15.
Wang F, Zhang J, Yu J, Liu S, Zhang R, Ma X, Yang Y, Wang P. Diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy: a systematic review and meta-analysis. J Diabetes Res. 2017;2017:8787261.
Petropoulos IN, Ponirakis G, Khan A, Almuhannadi H, Gad H, Malik RA. Diagnosing diabetic neuropathy: something old, something new. Diabetes Metab J. 2018;42(4):255-69.
Ackermann PW, Hart DA. Influence of comorbidities: neuropathy, vasculopathy, and diabetes on healing response quality. Adv Wound Care. 2013;2(8):410-21.
Stoberock K, Kaschwich M, Nicolay SS, Mahmoud N, Heidemann F, RieB HC, Debus ES, Behrendt CA. The interrelationship between diabetes mellitus and peripheral arterial disease. Vasa. 2021;50(5):323-30.
Wukich DK, Shen W, Raspovic KM, Suder NC, Baril DT, Avgerinos E. Noninvasive arterial testing in patients with diabetes: a guide for foot and ankle surgeons. Foot Ankle Int. 2015;36(12):1391-9.
Ding ZC, Zeng W, Rong X, Liang Z, Zhou ZK. Do patients with diabetes have an increased risk of impaired fracture healing? A systematic review and meta-analysis. ANZ J Surg. 2020;90(7-8):1259-64.
Macey LR, Kana SM, Jingushi S, Terek RM, Borretos J, Bolander ME. Defects of early fracture-healing in experimental diabetes. J Bone Joint Surg Am. 1989;71(5):722-33.
Topping RE, Bolander ME, Balian G. Type X collagen in fracture callus and the effects of experimental diabetes. Clin Orthop Relat Res. 1994;308:220-8.
Balint E, Szabo P, Marshall CF, Sprague SM. Glucose-induced inhibition of in vitro bone mineralization. Bone. 2001;28(1):21-8.
Terada M, Inaba M, Yano Y, Hasuma T, Nishizawa Y, Morii H, Otani S. Growth-inhibitory effect of a high glucose concentration on osteoblast-like cells. Bone. 1998;22(1):17-23.
Cortizo AM, Lettieri MG, Barrio DA, Mercer N, Etcheverry SB, McCarthy AD. Advanced glycation end-products (AGEs) induce concerted changes in the osteoblastic expression of their receptor RAGE and in the activation of extracellular signal-regulated kinases (ERK). Mol Cell Biochem. 2003;250(1-2):1-10.
Santana RB, Xu L, Chase HB, Amar S, Graves DT, Trackman PC. A role for advanced glycation end products in diminished bone healing in type 1 diabetes. Diabetes. 2003;52(6):1502-10.
Baltzis D, Eleftheriadou I, Veves A. Pathogenesis and treatment of impaired wound healing in diabetes mellitus: new insights. Adv Ther. 2014;31(8):817-36.
Lovy AJ, Dowdell J, Keswani A, Koehler S, Kim J, Weinfeld S, Joseph D. Nonoperative versus operative treatment of displaced ankle fractures in diabetics. Foot Ankle Int. 2017;38(3):255-60.
Costigan W, Thordarson DB, Debnath UK. Operative management of ankle fractures in patients with diabetes mellitus. Foot Ankle Int. 2007;28(1):32-7.
Schmidt T, Simske NM, Audet MA, Benedick A, Kim CY, Vallier HA. Effects of diabetes mellitus on functional outcomes and complications after torsional ankle fracture. J Am Acad Orthop Surg. 2020;28(16):661-70.
Guo JJ, Yang H, Xu Y, Wang G, Huang L, Tang T. Results after immediate operations of closed ankle fractures in patients with preoperatively neglected type 2 diabetes. Injury. 2009;40(8):894-6.
Konopitski AP, Malige A, Rodriguez W, Nwachuku CO. Surgical timing for torsional ankle fractures is not associated with post-operative complications in patients with type II diabetes mellitus. Arch Orthop Trauma Surg. 2022;142(12):3889-94.
Bazarov I, Peace RA, Lagaay PM, Patel SB, Lyon LL, Schuberth JM. Early protected weightbearing after ankle fractures in patients with diabetes mellitus. J Foot Ankle Surg. 2017;56(1):30-3.
Nash WJ, Hester T, Ha J. Current concepts and challenges in managing ankle fractures in the presence of diabetes: a systematic review of the literature. J Clin Orthop Trauma. 2021;17:44-53.
Jani MM, Ricci WM, Borrelli J, Barrett SE, Johnson JE. A protocol for treatment of unstable ankle fractures using transarticular fixation in patients with diabetes mellitus and loss of protective sensibility. Foot Ankle Int. 2003;24(11):838-44.
Rammelt S. Management of ankle fractures in the elderly. EFORT Open Rev. 2016;1(5):239-46.
Bazarov I, Kim J, Richey JM, Dickinson JD, Hamilton GA. Minimally invasive plate osteosynthesis for treatment of ankle fractures in high-risk patients. J Foot Ankle Surg. 2018;57(3):494-500.
Abdelgaid SM, Moursy AF, Elgebaly EAA, Aboelenien AM. Minimally invasive treatment of ankle fractures in patients at high risk of soft tissue wound healing complications. J Foot Ankle Surg. 2018;57(3):557-71.
Emara KM, Diab RA, Essa MN, Gemeah M, Emara YK, Fleifil S. Percutaneous cannulated screw fixation in the treatment for diabetic ankle fractures. Eur J Orthop Surg Traumatol. 2020;30(2):367-72.
Thevendran G, Younger A. Arthroscopic reduction and fibula nailing in high-risk diabetic ankle fractures: case reviews and technical tip. Foot Ankle Spec. 2012;5(2):124-7.
Ashman BD, Kong C, Wing KJ, Penner MJ, Bugler KE, White TO, Younger ASE. Fluoroscopy-guided reduction and fibular nail fixation to manage unstable ankle fractures in patients with diabetes. Bone Joint J. 2016;98-B(9):1197-201.
Dabash S, Eisenstein ED, Potter E, Kusnezov N, Thabet AM, Abdelgawad AA. Unstable ankle fracture fixation using locked fibular intramedullary nail in high-risk patients. J Foot Ankle Surg. 2019;58(2):357-62.
Xie B, Yan S, Zhang H, Wang YW, Tian J. Clinical efficacy of locked fibular nail for the treatment of lateral malleolus fractures in elderly patients with diabetes [in Chinese]. Zhongguo Gu Shang. 2018;31(3):237-40.
Ebaugh MP, Umbel B, Goss D, Taylor BC. Outcomes of primary tibiotalocalcaneal nailing for complicated diabetic ankle fractures. Foot Ankle Int. 2019;40(12):1382-7.
Grote CW, Tucker W, Stumpff K, Birt MC, Horton GA. Primary arthrodesis for diabetic ankle fractures. Foot Ankle Orthop. 2020;5(1):247301142090884.
Anderson JG, Bohay DR, Eller EB, Witt BL. Gastrocnemius recession. Foot Ankle Clin. 2014;19(4):767-86.
Zhou ZY, Liu YK, Chen HL, Liu F. Prevention of surgical site infection after ankle surgery using vacuum-assisted closure therapy in high-risk patients with diabetes. J Foot Ankle Surg. 2016;55(1):129-31.
Wukich DK, Dikis JW, Monaco SJ, Strannigan K, Suder NC, Rosario BL. Topically applied vancomycin powder reduces the rate of surgical site infection in diabetic patients undergoing foot and ankle surgery. Foot Ankle Int. 2015;36(9):1017-24.
Brutico AG, Nasser EM, Brutico JM. Operative ankle fractures in complicated diabetes: outcomes of prolonged non-weightbearing. J Foot Ankle Surg. 2022;61(3):542-50.
Liu JW, Ahn J, Raspovic KM, Liu GT, Nakonezny PA, Lavery LA, Wukich DK. Increased rates of readmission, reoperation, and mortality following open reduction and internal fixation of ankle fractures are associated with diabetes mellitus. J Foot Ankle Surg. 2019;58(3):470-4.
Pincus D, Veljkovic A, Zochowski T, Mahomed N, Ogilivie-Harris D, Wasserstein D. Rate of and risk factors for intermediate-term reoperation after ankle fracture fixation: a population-based cohort study. J Orthop Trauma. 2017;31(10):e315-20.
Ganesh SP, Pietrobon R, Cecilio WACR, Pan D, Lightdale N, Nunley JA. The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am. 2005;87(8):1712-8.
Dodd AC, Lakomkin N, Attum B, Bulka C, Karhade AV, Douleh DG, Mir H, Jahangir AA, Obremskey WT, Sethi MK. Predictors of adverse events for ankle fractures: an analysis of 6800 patients. J Foot Ankle Surg. 2016;55(4):762-6.
Neumann AP, Kroker L, Beyer F, Rammelt S. Complications following surgical treatment of posterior malleolar fractures: an analysis of 300 cases. Arch Orthop Trauma Surg. 2022. doi:10.1007/s00402-022-04536-9.
doi: 10.1007/s00402-022-04536-9
SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS. Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am. 2009;91(5):1042-9.
Wukich DK, Lowery NJD, McMillen RLD, Frykberg RGD. Postoperative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus. J Bone Joint Surg Am. 2010;92(2):287-95.
Ng A, Barnes ES. Management of complications of open reduction and internal fixation of ankle fractures. Clin Podiatr Med Surg. 2009;26(1):105-25.