Session VIII - Foot and Ankle

Ankle Fractures in Diabetics - The Risks of Treatment

Jordan Leith, MD, Robert G. McCormack, MD

University of British Columbia, New Westminster, British Columbia, Canada

Purpose: To determine the effects of diabetes and risk of complications in treating ankle fractures.

Method and Results: Twenty-six patients with diabetes mellitus and malleolar fractures were compared to twenty-six non-diabetic controls. The controls were matched for patient age, fracture type and treating surgeon. The groups were well-matched, although there was a tendency for more severe fractures (bi-malleolar and tri-malleolar) in the non-diabetic controls. There were eleven major complications in the twenty-six diabetics (42.3%) compared to none in the matched group of non-diabetics. This difference was highly significant at P=0.001 (Fisher exact test). Of the nineteen diabetic patients treated operatively, five developed significant wound complications, including wound edge necrosis requiring local flap closure in one, deep wound infection with septic arthritis in two, and fulminating infection leading to amputation and death in two. Four of the five operatively treated diabetics who developed wound problems, and both of the patients who died, were insulin dependent. A high percentage of the non-operatively treated diabetics developed a malunion, but these were only minimally symptomatic, and all had a functional lower limb.

Discussion: Diabetic patients who present with traumatic ankle fractures are at high risk of developing complications. The absence of complications in a group of non-diabetics matched for age, treating surgeon, as well as fracture type, would suggest the differences were attributable to the presence or absence of diabetes, rather than the institution or treating surgeon. Given the high incidence of operative complications, it may be preferable to accept loss of reduction and malunion, particularly in the older, lower- demand diabetic. If surgical intervention is deemed necessary, this case- controlled study will allow more accurate assessment of surgical risks.

Conclusion: There was an overall complication rate of 42.3% in diabetics with ankle fractures compared to 0% in a group of non-diabetics, matched for patient age, fracture type and treating surgeon.