How To Treat Ankle Fractures In Patients With Diabetes

By Alan R. Catanzariti, DPM, Robert W. Mendicino, DPM, and Travis L. Sautter, DPM
This outcome data included assessments of ankle fracture type and severity, time to full weightbearing and fracture union, and the incidence of nonunion and wound problems. There was also no statistical difference between the demographic and outcome data of patients with type 1 diabetes and the results among those with type 2 diabetes. Overall, there were no major complications of Charcot arthropathy, limb loss or death in this study population. This study demonstrates a low complication rate for the surgical treatment of diabetic ankle fractures relative to the existing literature. Final Words An ankle fracture in a patient with longstanding diabetes mellitus can be a calamity for the patient and the physician who treats this fracture as a routine injury. Therefore, one should manage these patients with special precautions. In order to help achieve the best outcomes, it is essential to consider key factors that may predispose patients with diabetic neuropathy to complications resulting from an ankle fracture. Dr. Catanzariti is the Director of the Residency Training Program within the Division of Foot and Ankle Surgery at the Western Pennsylvania Hospital in Pittsburgh. He is a Fellow of the American College of Foot and Ankle Surgeons. 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 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. 6. McCormack RG, Leith JM. Ankle fractures in diabetics. Complications of surgical management. J Bone Joint Surg Br. 80(4):689-92, 1998. 7. Flynn JM, Rodriguez-del Rio F, Piza PA. Closed ankle fractures in the diabetic patient. Foot Ankle Int. 21(4):311-319, 2000. 8. Beam HA, Parsons JR, Lin SS. The effects of blood glucose upon fracture healing in the BB Wistar rat with diabetes mellitus. J Orthop Res. 20(6):1210-1216, 2002. 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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