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. 2021 Feb 3:17:44-53.
doi: 10.1016/j.jcot.2021.01.016. eCollection 2021 Jun.

Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

William J Nash  1 , Thomas Hester  2 , Joon Ha  3
Affiliations

Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

William J Nash et al. J Clin Orthop Trauma. .

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.

Keywords: Amputation; Ankle Fractures; Charcot; Complication; Diabetes; Systematic review.

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Conflict of interest statement

All authors were fully involved in the study and preparation of the manuscript and the material within has not been and will not be submitted for publication elsewhere. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare that they have no conflicts of interest in the publication of this manuscript.

Figures

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Article selection process.
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Stratification of included articles.
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Scoring of selected articles.
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Questions used to score articles.
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Summary of included articles.
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Fig. 5
Summary of included articles.
Fig. 5
Fig. 5
Summary of included articles.
See this image and copyright information in PMC

References

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