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Surgical Treatment of Ankle Fractures in Patients with Diabetes

Having diabetes can complicate the healing of a fracture. This is especially true with an ankle fracture when the diabetes has resulted in loss of blood and nerve supply to the foot. Delayed fracture healing and impaired wound healing can cause major complications for the patient.

The surgical management of ankle fractures in diabetic patients is the focus of this report. Surgery for patients with diabetes is avoided whenever possible because the rate of complications is almost 50 per cent. If the patient is elderly and inactive, then conservative care (even with a nonunion as the final result) may be best.

Surgery is advised when the fracture is displaced. Surgeons are aware of the high rate of problems common in diabetic patients with ankle fractures. Special techniques have been developed to help prevent these problems.

Sometimes the surgery has to be staged. This means it is done in a series of steps. For example, the bones may be reduced (put back in place and lined up) first. Then soft tissue trauma causing swelling must be treated before further surgery can be done. External fixation with a metal rod along the outside of the leg and pins through the bones may be needed.

The authors discuss a wide variety of fixation methods. The use of wires, pins, standard and locking plates, and self-threading screws is presented. Many X-rays taken before and after surgery are used to explain these approaches. Special problems such as osteopenia (low bone mass) or osteoporosis (brittle bones) are taken into consideration.

The authors remind surgeons that treatment for ankle fractures in this group of adults takes much longer than in a similar patient without diabetes. Cast immobilization, as part of the nonoperative care plan can take two to three times longer than for a nondiabetic patient. Weight-bearing isn't allowed until fracture healing is seen on X-rays.

A multidisciplinary team approach works best. Goals include maintaining good blood-glucose levels, providing oxygen supply to the healing limb, and minimizing problems that could cause limb-threatening complications.

References: Saad B. Chaudhary, MD, MBA, et al. Complications of Ankle Fracture in Patients with Diabetes. In Journal of the American Academy of Orthopaedic Surgeons. March 2008. Vol. 16. No. 3. Pp. 159-170.

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