How To Treat Ankle Fractures In Patients With Diabetes

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In particular, when one is managing diabetic ankle fractures, the treating physician should have a high index of suspicion for the development of Charcot.
For unstable ankle fractures and significant deformity in patients with diabetes, one should consider surgical management. Surgical options may include ORIF or closed reduction with percutaneous and/or external fixation.
When performing surgical treatment of ankle fractures in patients with diabetes, the authors emphasize using an adequate fixation construct for these patients due to the incidence of osteopenia and neuropathy.
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Author(s): 
By Alan R. Catanzariti, DPM, Robert W. Mendicino, DPM, and Travis L. Sautter, DPM

Dr. Mendicino is Chief of the Division of Foot and Ankle Surgery at the Western Pennsylvania Hospital in Pittsburgh. He is a Fellow and Past President of the American College of Foot and Ankle Surgeons, and is a Clinical Professor of Surgery at the Western Campus of the Temple University School of Podiatric Medicine.

Dr. Sautter is a Chief Resident of Foot and Ankle Surgery at Western Pennsylvania Hospital in Pittsburgh.




References:

References
1. Cavanaugh PR, Young MJ, Adams JE, Vickers KL, Boulton AJ. Radiographic abnormalities in the feet of patients with diabetic neuropathy. Diabetes Care. 17(3): 201-209, 1994.
2. Reddy GK, Stehno-Bittel L, Hamade S, Enwemeka CS. The biomechanical integrity of bone in experimental diabetes. Diabetes Res Clin Pract. 54(1):1-8, 2001
3. Ivers RQ, Cumming RG, Mitchell P. Diabetes and risk of fracture: The blue mountains eye study. Diabetes Care. 24(7): 1198-1203, 2001.
4. Bibbo C, Lin SS, Beam HA, Behrens FF. Complications of ankle fractures in diabetic patients. Orthopedic Clinics of North America. 32(1):113-133, 2001.
5. Young MJ, Marshall A, Adams JE, Selby PL, Boulton AJ. Osteopenia, neurological dysfunction, and the development of Charcot neuroarthropathy. Diabetes Care. 18(1):34-38, 1995.
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9. Selby PL, Young MJ, Boulton AJ. Bisphosphonates: a new treatment for diabetic Charcot neuroarthropathy? Diabet Med. 11(1):28-31, 1994.
10. Jude EB, Selby PL, Burgess J, Lilleystone P, Mawer EB, Page SR, Donohoe M, Foster AV, Edmonds, ME, Boulton AJ. Bisphosphonates in the treatment of Charcot neuroarthropathy: a double-blind randomized controlled trial. Diabetologia. 44(11):2032-2037, 2001.
11. White CB, Turner NS, Lee GC, Haidukewych GJ. Open ankle fractures in patients with diabetes mellitus. Clin Orthop Relat Res. (414):37-44, 2003.
12. Bankston AB, Anderson LD, Nimityongskul P. Intramedullary screw fixation of lateral malleolus fractures. Foot Ankle Int. 15(11):599-607, 1994.
13. 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. 24(11):838-844, 2003.

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