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Review
. 2020 Sep 10;5(8):457-463.
doi: 10.1302/2058-5241.5.200025. eCollection 2020 Aug.

Ankle fractures in diabetic patients

Nikolaos Gougoulias  1 , Hesham Oshba  1 , Apostolos Dimitroulias  2 , Anthony Sakellariou  1 , Alexander Wee  1
Affiliations
Review

Ankle fractures in diabetic patients

Nikolaos Gougoulias et al. EFORT Open Rev. .

Abstract

Surgical complications are more common in patients with complicated diabetes (presence of inner organ failure, neuropathy).Of all patients undergoing ankle fracture fixation, approximately 13% are diabetic and 2% have complicated diabetes mellitus.Non-operative management of ankle fractures in patients with complicated diabetes results in an even higher rate of complications.Insufficient stability of ankle fractures (treated operatively, or non-operatively) can trigger Charcot neuroarthropathy, and result in bone loss, deformity, ulceration, and the need for amputation.Rigid fixation is recommended. Hindfoot arthrodesis (as primary procedure or after failed ankle fracture management) can salvage the limb in approximately 80% of patients.Early protected weight bearing can be allowed, provided rigid fixation without deformity has been achieved. Cite this article: EFORT Open Rev 2020;5:457-463. DOI: 10.1302/2058-5241.5.200025.

Keywords: ankle fractures; diabetic; fixation.

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Conflict of interest statement

ICMJE Conflict of interest statement: NG reports accommodation and travel expenses paid for participation as faculty (member of EFAS Education Committee) in the EFAS Instructional Courses outside the submitted work. AW reports consultancy for Bonesupport – being paid to give lectures on treatment of osteomyelitis in diabetic feet, outside the submitted work. AS reports travel and accommodation expenses paid by learned bodies/societies when attending to give invited lectures or to teach on courses, part funding for a fellowship programme from Zimmer/Biomet, and funding and administrative support for conducting clinical research trial of implant from Carticept Inc., Atlanta, Georgia, all outside the submitted work. The other authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
Charcot neuroarthropathy of the ankle after non-operative management of an unstable ankle fracture.
Fig. 2
Fig. 2
Unstable fracture in a 70-year-old diabetic patient, treated initially with external fixation and ‘minimal’ internal fixation (a, b), complicated by joint destruction due to Charcot neuroarthropathy, without signs of infection. It was salvaged with ankle arthrodesis using a rigid fixation construct (plate with locking screws, augmented by tibiotalar compression screws) (c, d).
Fig. 3
Fig. 3
A 65-year-old alcohol-dependent, psychotic, insulin-dependent diabetic male patient, with chronic renal failure, had sustained ankle and foot injury nine months before. ‘Minimal’ percutaneous fixation was applied to the midfoot, whilst the ankle injury was treated non-operatively. Charcot neuroarthropathy of ankle and midfoot (a, b), resulted in gross deformity (c) and ulceration (d). A below-knee amputation was required (e, f).
Fig. 4
Fig. 4
A 70-year-old female patient, with diabetic neuropathy and limited mobility, on haemodialysis for chronic renal failure, sustained a bimalleolar fracture (a, b). Due to her poor general health and ankle swelling her surgery was postponed for two weeks, and she developed Charcot neuroarthropathy (c, d). Tibio-talo-calcaneal arthrodesis using retrograde hindfoot nail was performed (e, f) in order to salvage the limb. Arthrodesis, in good alignment, showed signs of union already at six weeks (g, h).
See this image and copyright information in PMC

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