BACKGROUND: An increased rate of complications has been clearly shown in diabetic patients undergoing operative treatment for displaced ankle fractures. To date, no studies have specifically looked at the complication rates following the operative management of pilon fractures in this difficult patient population. We performed a retrospective review to determine the rates of complications in diabetic patients undergoing operative fixation of tibial pilon fractures compared with a control group of patients without diabetes. MATERIALS AND METHODS: The trauma registry was utilized to identify all patients who underwent primary treatment for a tibial pilon fracture between January 2005 and June of 2007 at a single Level 1 trauma center. A minimum of 6-month followup was required for inclusion. A chart and radiographic review was completed to identify the complications seen in each patient population. Specifically, we looked at the rate of infection (superficial and deep), the rate of nonunion or delayed union, and the rate of surgical wound complications. RESULTS: A total of 14 fractures in 13 diabetic patients, and 69 fractures in 68 non-diabetic patients met inclusion criteria. In the diabetic patient group, the average age was 48 years, the average BMI was 35, and 36% of the fractures were open. In the non-diabetic group, the average age was 47 years, the average BMI was 29, and 35% of the fractures were open. Only the difference in BMI was statistically significant. The infection rate was 71% for diabetic patients (43% deep infection), and 19% for non-diabetic patients (9% deep infection) [p < 0.001, odds ratio 10.719 (95% confidence interval 2.914 to 39.798)]. Overall, the rate of non-union/delayed union was 43% in the diabetic group versus 16% in the non-diabetic group [p = 0.02, odds ratio 3.955 (95% confidence interval 1.145 to 13.656)]. The rate of surgical wound complications was 7% in both the non-diabetic and diabetic patient groups. CONCLUSION: The management of tibial pilon fractures in diabetic patients is difficult, with a high rate of complications compared to non-diabetic patients. These results mirror those previously reported for ankle fractures in diabetic patients.
BACKGROUND: An increased rate of complications has been clearly shown in diabeticpatients undergoing operative treatment for displaced ankle fractures. To date, no studies have specifically looked at the complication rates following the operative management of pilon fractures in this difficult patient population. We performed a retrospective review to determine the rates of complications in diabeticpatients undergoing operative fixation of tibial pilon fractures compared with a control group of patients without diabetes. MATERIALS AND METHODS: The trauma registry was utilized to identify all patients who underwent primary treatment for a tibial pilon fracture between January 2005 and June of 2007 at a single Level 1 trauma center. A minimum of 6-month followup was required for inclusion. A chart and radiographic review was completed to identify the complications seen in each patient population. Specifically, we looked at the rate of infection (superficial and deep), the rate of nonunion or delayed union, and the rate of surgical wound complications. RESULTS: A total of 14 fractures in 13 diabeticpatients, and 69 fractures in 68 non-diabeticpatients met inclusion criteria. In the diabeticpatient group, the average age was 48 years, the average BMI was 35, and 36% of the fractures were open. In the non-diabetic group, the average age was 47 years, the average BMI was 29, and 35% of the fractures were open. Only the difference in BMI was statistically significant. The infection rate was 71% for diabeticpatients (43% deep infection), and 19% for non-diabeticpatients (9% deep infection) [p < 0.001, odds ratio 10.719 (95% confidence interval 2.914 to 39.798)]. Overall, the rate of non-union/delayed union was 43% in the diabetic group versus 16% in the non-diabetic group [p = 0.02, odds ratio 3.955 (95% confidence interval 1.145 to 13.656)]. The rate of surgical wound complications was 7% in both the non-diabetic and diabeticpatient groups. CONCLUSION: The management of tibial pilon fractures in diabeticpatients is difficult, with a high rate of complications compared to non-diabeticpatients. These results mirror those previously reported for ankle fractures in diabeticpatients.
Authors: Krzysztof Piątkowski; Piotr Piekarczyk; Krzysztof Kwiatkowski; Mateusz Przybycień; Bartłomiej Chwedczuk Journal: Int Orthop Date: 2015-07-15 Impact factor: 3.075
Authors: Kirsten Kortram; Hans Bezstarosti; Willem-Jan Metsemakers; Michael J Raschke; Esther M M Van Lieshout; Michael H J Verhofstad Journal: Int Orthop Date: 2017-07-25 Impact factor: 3.075
Authors: Masato Yuasa; Nicholas A Mignemi; Jeffry S Nyman; Craig L Duvall; Herbert S Schwartz; Atsushi Okawa; Toshitaka Yoshii; Gourab Bhattacharjee; Chenguang Zhao; Jesse E Bible; William T Obremskey; Matthew J Flick; Jay L Degen; Joey V Barnett; Justin M M Cates; Jonathan G Schoenecker Journal: J Clin Invest Date: 2015-07-27 Impact factor: 14.808
Authors: Ushashi C Dadwal; Caio de Andrade Staut; Nikhil P Tewari; Olatundun D Awosanya; Stephen K Mendenhall; Conner R Valuch; Rohit U Nagaraj; Rachel J Blosser; Jiliang Li; Melissa A Kacena Journal: J Orthop Res Date: 2021-03-26 Impact factor: 3.494