Current Insights In Treating Diabetic Foot And Ankle Trauma

Start Page: 16
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Author(s): 
John J. Stapleton, DPM, FACFAS, and Thomas Zgonis, DPM, FACFAS

   For example, one may need to perform a medial column arthrodesis for a neuropathic navicular comminuted fracture. Severe fracture patterns that are not amenable to reconstruction are better to stabilize initially with an external fixator in order to enhance the overall alignment of the osseous segments and in preparation of a staged salvage arthrodesis. One often sees this with certain high-energy pilon and calcaneal fractures.

In Conclusion

Despite the most appropriate surgical management, many diabetic foot and ankle injuries may still have a poor prognosis. For this reason, careful evaluation and incorporation of a healthcare team with knowledge in the overall treatment of diabetes mellitus and its related complications are essential for the patient’s successful recovery.

   Dr. Stapleton is an Associate in Foot and Ankle Surgery at VSAS Orthopaedics in Allentown, Pa. He is a Clinical Assistant Professor of Surgery at the Penn State College of Medicine in Hershey, Pa.

   Dr. Zgonis is an Associate Professor, Fellowship Director and Chief of the Division of Podiatric Medicine and Surgery within the Department of Orthopaedics at the University of Texas Health Science Center at San Antonio. He is the Founder and Co-Chairman of the International External Fixation Symposium (IEFS), which is held annually in December in San Antonio.

References

1. Chaudhary SB, Liporace FA, Gandhi A, Donley BG, Pinzur MS, Lin SS. Complications of ankle fracture in patients with diabetes. J Am Acad Orthop Surg 2008;16(3):159-70.
2. Wukich DK, Kline AJ. The management of ankle fractures in patients with diabetes. J Bone Joint Surg Am 2008;90(7):1570-8.
3. Jani MM, Ricci WM, Borrelli J Jr, 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.
4. DiDomenico LA, Brown D, Zgonis T. The use of Ilizarov technique as a definitive percutaneous reduction for ankle fractures in patients who have diabetes and peripheral vascular disease. Clin Podiatr Med Surg 2009; 26(1):141-148.
5. Ramanujam CL, Facaros Z, Zgonis T. Perioperative management of the dysvascular foot and ankle. Perioperative Nursing Clinics 2011;6(1):17-26.
6. Kline AJ, Gruen GS, Pape HC, Tarkin IS, Irrgang JJ, Wukich DK. Early complications following the operative treatment of pilon fractures with and without diabetes. Foot Ankle Int 2009;30(11):1042-7.
7. Wukich DK, Joseph A, Ryan M, Ramirez C, Irrgang JJ. Outocomes of ankle fractures in patients with uncomplicated versus complicated diabetes. Foot Ankle Int 2011; 32(2); 120-30.
8. Marin LE, DiDomenico LA, Stamatis ED, Zgonis T. Diabetic neuropathic pilon and ankle osseous trauma and dislocations. In: Zgonis T (ed): Surgical Reconstruction of the Diabetic Foot and Ankle. Lippincott Williams & Wilkins, Philadelphia, Pa., 2009, pp. 357-374.
9. Marin LE, DiDomenico LA, Mandracchia VJ, Zgonis T. Diabetic neuropathic forefoot, midfoot and hindfoot osseous trauma and dislocations. In: Zgonis T (ed): Surgical Reconstruction of the Diabetic Foot and Ankle. Lippincott Williams & Wilkins, Philadelphia, Pa., 2009, pp. 344-356.
10. Facaros Z, Stapleton JJ, Polyzois VD, Zgonis T. Management of foot and ankle trauma. Perioperative Nursing Clinics 2011;6(1):35-43.
11. Facaros Z, Ramanujam CL, Zgonis T. Primary subtalar joint arthrodesis with internal and external fixation for the repair of a diabetic comminuted calcaneal fracture. Clin Podiatr Med Surg 2011;28(1):203-209.

   For further reading, see “Proactive Measures To Prevent Diabetic Complications” in the October 2005 issue of Podiatry Today, “How To Treat Ankle Fractures In Patients With Diabetes” in the April 2006 issue or “Do Trauma Patients With Diabetes Face Higher Complication Rates?” in the October 2007 issue.

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