William J Nash1, Thomas Hester2, Joon Ha3. 1. Consultant Orthopaedic Surgeon, St Mary's Orthopaedics, Portland, ME, USA. 2. Consultant Orthopaedic Surgeon, University Hospital Lewisham, London, UK. 3. Trauma & Orthopaedic Registrar, King's College Hospital, London, UK.
Abstract
BACKGROUND: Ankle fractures in diabetic patients are known to have an increased morbidity. This systematic review aims to evaluate the current evidence in terms of risk profile and inform treatment options. METHODS: Following the methodology of the Cochrane collaboration, an extensive literature search was conducted. Outcomes included, complications, operative and non-operative management and early weight-bearing. RESULTS: A total of 40 studies were included. Complication rates were higher in diabetic patients and more so in poorly controlled diabetes, IDDM, or "complicated" diabetes. Supplementary fixation was associated with lower complication rates. Regarding early weight-bearing, similar results to non-diabetics in the stable fracture pattern were found providing there was no evidence of neuropathy. CONCLUSION: Diabetes, especially complicated diabetes, presents an increased risk of complications. However non operative management of diabetic ankle fractures do poorly, and with the use of 'ORIF plus' techniques there is no increase in complications from early fixation. The use of external fixation for definitive fixation should be minimised as it is associated with high complication rates.
BACKGROUND: Ankle fractures in diabetic patients are known to have an increased morbidity. This systematic review aims to evaluate the current evidence in terms of risk profile and inform treatment options. METHODS: Following the methodology of the Cochrane collaboration, an extensive literature search was conducted. Outcomes included, complications, operative and non-operative management and early weight-bearing. RESULTS: A total of 40 studies were included. Complication rates were higher in diabetic patients and more so in poorly controlled diabetes, IDDM, or "complicated" diabetes. Supplementary fixation was associated with lower complication rates. Regarding early weight-bearing, similar results to non-diabetics in the stable fracture pattern were found providing there was no evidence of neuropathy. CONCLUSION: Diabetes, especially complicated diabetes, presents an increased risk of complications. However non operative management of diabetic ankle fractures do poorly, and with the use of 'ORIF plus' techniques there is no increase in complications from early fixation. The use of external fixation for definitive fixation should be minimised as it is associated with high complication rates.
Authors: Christy M King; Mathew Cobb; David R Collman; Pieter M Lagaay; Jason D Pollard Journal: J Foot Ankle Surg Date: 2012 Jan-Feb Impact factor: 1.286
Authors: Mikko T Ovaska; Tatu J Mäkinen; Rami Madanat; Kaisa Huotari; Tero Vahlberg; Eero Hirvensalo; Jan Lindahl Journal: J Bone Joint Surg Am Date: 2013-02-20 Impact factor: 5.284