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Fadle AA, El-Adly W, Fekry MA, Osman AE, Khalifa AA. Primary arthrodesis for diabetic ankle fractures using a modified retrograde femoral intramedullary locking nail combined with lateral plating, surgical technique, and early results of a pilot study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2549-2556. [PMID: 38693347 PMCID: PMC11291572 DOI: 10.1007/s00590-024-03947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE We aimed to report the early results of performing acute ankle arthrodesis using a modified retrograde femoral intramedullary locking IMN concomitant with plating at the same setting for managing diabetic patients' acute ankle fractures. METHODS We prospectively included patients who presented acutely with ankle fractures, where hemoglobin A1C (HbA1C) on admission was > 7%, and the Adelaide Fracture in the Diabetic Ankle (AFDA) algorithm score was 5 or above. All patients were treated by acute ankle arthrodesis using a modified retrograde femoral IMN combined with lateral plating. Functional assessment was reported according to a modified American Orthopaedic Foot and Ankle Society ankle hindfoot scale (AOFAS), and complications were documented. RESULTS Six patients had an average age of 55.7 years (37-65). The average HbA1C on admission was 7.9 (7.3-9), and the average AFDA score was 7.3 (6-8). The average operative time was 79.2 min (70-90). All patients, except for one, achieved union at the arthrodesis site after an average of 10.3 weeks (8-14). After an average last follow-up of 9 months (6-12), the average modified AOFAS was 73.2 (82 to 62); four patients had an excellent score and one good. Complications developed in two, one deep infection after 2 weeks treated by metal removal and Ilizarov, and the other patient developed a stress fracture at the tibial end of the nail, which was treated by open reduction and internal fixation using a plate and screws. CONCLUSION Using a modified femoral IMN combined with lateral plating is a promising technique to achieve ankle arthrodesis in diabetic patients with acute ankle fractures with acceptable outcomes; however, further studies with larger numbers are needed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Amr A Fadle
- Department of Orthopedic, Assiut University Hospital, Assiut, Egypt
| | - Wael El-Adly
- Department of Orthopedic, Assiut University Hospital, Assiut, Egypt
| | | | - Ahmed E Osman
- Department of Orthopedic, Assiut University Hospital, Assiut, Egypt
| | - Ahmed A Khalifa
- Department of Orthopedic, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, 83523, Egypt.
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Tsatlidou M, Vasiliadis AV, Metaxiotis D. What the Physician Needs to Know about Charcot Arthropathy and Ankle Fracture Treatment Dilemma: A Case Report and a Possible Medical Approach and Treatment Algorithm. J Orthop Case Rep 2024; 14:45-51. [PMID: 38910990 PMCID: PMC11189088 DOI: 10.13107/jocr.2024.v14.i06.4498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/22/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Charcot arthropathy consists of a rapid and destructive complication of the joints following the loss of innervation caused by many complicated etiologies. Diabetic neuropathy has become the most common etiological factor. Case Report We present a case of a 64-year-old female patient with a history of chronic renal failure on hemodialysis, hypertension, hypothyroidism, and Type 2 diabetes, complicated with neuropathy and Charcot disease, who referred to our department. Initially, the patient was managed with a restraint orthotic device due to a bimalleolar ankle fracture. An unsuccessful treatment and the presence of a pressure ulcer with pus-like drainage on the lateral malleolus 2 months later led to the decision for a below-knee amputation. Conclusion High clinical suspicion by the attending physician may reduce the risk of complications and lead to proper treatment with better outcomes.
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Affiliation(s)
- Maria Tsatlidou
- nd Orthopaedic Department, General Hospital of Thessaloniki “Papageorgiou”, 56429 Thessaloniki, Greece
| | - Angelo V Vasiliadis
- nd Orthopaedic Department, General Hospital of Thessaloniki “Papageorgiou”, 56429 Thessaloniki, Greece
- Department of Orthopaedic Surgery and Sports Medicine, Croix-Rousse Hospital, 69002 Lyon, France
| | - Dimitrios Metaxiotis
- nd Orthopaedic Department, General Hospital of Thessaloniki “Papageorgiou”, 56429 Thessaloniki, Greece
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Abstract
Successful outcomes in the surgical treatment of the fractured ankle require methods that respect the soft tissue envelope and establish a stable mortise for functional rehabilitation. Ankle fractures in patients with osteopenia and in diabetic patients with deranged bone remodeling constitute high-risk injuries that may result in catastrophic complications. These patients present unique care challenges and should not be approached in the same manner as their healthy counterparts. We present the principles of treatment in high-risk ankle fractures, operative treatment philosophy illustrating techniques frequently used at our institution, and a review of current literature.
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Affiliation(s)
- Craig E Krcal
- The CORE Institute, 18444 N 25th Avenue Suite 320, Phoenix, AZ 85023, USA; Kaiser San Francisco Bay Area Foot & Ankle Residency Program Alumni Class of 2023
| | - David R Collman
- Kaiser San Francisco Bay Area Foot & Ankle Residency Program; Department of Orthopedics, Podiatry, Injury, Sports Medicine; Kaiser Permanente San Francisco Medical Center, 450 6th Avenue, French Campus, 5th Floor, San Francisco, CA 94118, USA.
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Arteaga A, Biguetti CC, Chandrashekar B, La Fontaine J, Rodrigues DC. Revolutionizing fracture fixation in diabetic and non-diabetic rats: High mobility group box 1-based coating for enhanced osseointegration. Bone 2023; 177:116917. [PMID: 37739297 PMCID: PMC11292581 DOI: 10.1016/j.bone.2023.116917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
Chronic inflammation and hyperglycemia in diabetic patients increase the risk of implant failure and impaired fracture healing. We previously developed and characterized a titanium (Ti) coating strategy using an imidazolium-based ionic liquid (IonL) with a fully reduced, non-oxidizable High Mobility Group Box 1 (HMGB1) isoform (Ti-IonL-HMGB1) to immunomodulate tissue healing. In this study, we used an open reduction fracture fixation (ORIF) model in non-diabetic (ND) and diabetic (D) rats to further investigate the effectiveness of this Ti-IonL-HMGB1 coating on orthopedic applications. Ninety male Lewis rats (12-15 weeks) were divided into D (n = 45) and ND (n = 45) groups that were distributed into three subgroups based on the type of local treatment received: Ti (uncoated Ti), Ti-IonL, and Ti-IonL-HMGB1 implants. Fracture healing and osseointegration were evaluated using microtomographic, histological, and immunohistochemical analysis of proliferating cell nuclear antigen (PCNA), Runt-related transcription factor 2 (RUNX2), and HMGB1 markers at 2, 10, and 21 days post-ORIF. Scanning Electron Microscopy verified the coating stability after placement. Microtomographic and histological analysis demonstrated increased fracture healing and osseointegration for ND rats in all treatment groups at 10 days, with impaired healing for D rats. Immunohistochemical analysis exhibited elevated PCNA+ and RUNX2+ cells for D animals treated with Ti-IonL-HMGB1 at 21 days compared to all other groups. The immunohistochemical marker HMGB1 was elevated at all time points for D animals in comparison to ND animals, yet was lowered for D tissues near the Ti-IonL-HMGB1 treated implant. Improved osseous healing was demonstrated in D animals with Ti-IonL-HMGB1 treatment by 21 days, compared to D animals with other treatments. To the best of our knowledge, this is the first study analyzing Ti-IonL-HMGB1 implantation in an injury site through ORIF procedures in ND and D rats. This surface approach has potential for improving implanted biomaterials in diabetic environments.
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Affiliation(s)
- Alexandra Arteaga
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, USA
| | - Claudia Cristina Biguetti
- Department of Surgery and Biomechanics, School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, USA
| | | | - Javier La Fontaine
- Department of Surgery and Biomechanics, School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Danieli C Rodrigues
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, USA.
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Reyes-Valdés A, Martínez-Ledezma M, Fernández-Quezada D, Guzmán-Esquivel J, Cárdenas-Rojas MI. Prevalence and Characteristics of Patients Requiring Surgical Reinterventions for Ankle Fractures. J Clin Med 2023; 12:5843. [PMID: 37762784 PMCID: PMC10532131 DOI: 10.3390/jcm12185843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Ankle fractures are common injuries that typically require surgical treatment. Complications may arise, leading to reinterventions with poor recovery and reduced quality of life for patients. The aim of this study was to determine the number of patients who underwent surgical reintervention for ankle fractures, characteristics, and associated factors. (2) Methods: A cross-sectional study was conducted to analyze the number of patients requiring surgical intervention for ankle fractures at General Hospital Zone No1 IMSS in Colima over a period of two years. The age, gender, comorbidities, laterality, cause of surgical reintervention, Weber classification, and elapsed time to reintervention were analyzed. (3) Results: A total of 33 patients were included in this study, of whom 63.3% were male, ranging in age from 18 to 51 years old. The predominant Danis-Weber classification for both sexes was suprasyndesmotic fracture (Type C). No established relationship was found between comorbidities and surgical reintervention; however, a significant relationship was observed between home accidents and the need for reintervention. (4) Conclusions: Reintervention in patients previously operated on for ankle fractures is more frequent in male patients and those who sustained the injury at home.
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Affiliation(s)
- Abraham Reyes-Valdés
- Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Av. Lapislázuli No. 250 Colonia La Haya, Villa de Álvarez, Colima 28984, Mexico; (A.R.-V.); (M.M.-L.)
| | - Mirna Martínez-Ledezma
- Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, Av. Lapislázuli No. 250 Colonia La Haya, Villa de Álvarez, Colima 28984, Mexico; (A.R.-V.); (M.M.-L.)
| | - David Fernández-Quezada
- Centro Universitario de Ciencias de la Salud (CUCS), Laboratorio de Microscopía de Alta Resolución, Departamento de Neurociencias, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - José Guzmán-Esquivel
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli No. 250 Colonia La Haya, Villa de Álvarez, Colima 28984, Mexico;
| | - Martha Irazema Cárdenas-Rojas
- Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Av. Lapislázuli No. 250 Colonia La Haya, Villa de Álvarez, Colima 28984, Mexico;
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Arteaga A, Biguetti CC, Chandrashekar BL, Mora J, Qureshi A, Rios E, La Fontaine J, Rodrigues DC. A Model Study to Evaluate Osseointegration and Fracture Healing Following Open Reduction and Internal Fixation (ORIF) in Diabetic Lewis Rats. J Foot Ankle Surg 2023; 62:832-839. [PMID: 37169119 PMCID: PMC11292579 DOI: 10.1053/j.jfas.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Abstract
There is a higher risk of implant osseointegration failure after open reduction and internal fixation (ORIF) in patients with diabetes due to increased inflammatory conditions, associated metallic corrosion and infection. While it is possible to avoid elective osseous surgery in patients with diabetes, it may not be the case in nonelective cases, such as ORIF ankle fractures. A total of 30 male Lewis rats (12-15 weeks old) were distributed into diabetic (D) and nondiabetic (ND) groups. Fracture healing and osseointegration were evaluated at 2-, 10-, and 21-day time points. Microtomographic and histological analysis depicted distinct differences in fracture healing and osseointegration between D and ND animals. Immunohistochemical analysis exhibited elevated proliferation (PCNA) and osteogenic (Runx2) cells for ND animals, while HMGB1 (inflammatory marker) was elevated for D animals during healing. Bone resorption marker CTX-1 was elevated in the plasma of D animals at 2 days, while bone formation marker P1NP was higher for ND animals at 10 days. Overall, this model resulted in delayed implant osseointegration and fracture healing in diabetic animals, highlighting the importance of developing new biomaterials or implant coatings that can improve bone healing outcomes in this patient population.
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Affiliation(s)
- Alexandra Arteaga
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Claudia Cristina Biguetti
- Department of Surgery and Biomechanics, School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX
| | | | - Jimena Mora
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Adeena Qureshi
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Evelin Rios
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Javier La Fontaine
- Department of Surgery and Biomechanics, School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX
| | - Danieli C Rodrigues
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX.
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Ziegler P, Bahrs C, Konrads C, Hemmann P, Ahrend MD. Ankle fractures of the geriatric patient: a narrative review. EFORT Open Rev 2023; 8:1-10. [PMID: 36705613 PMCID: PMC9969005 DOI: 10.1530/eor-22-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The present narrative review provides a summary of current concepts for the treatment of ankle fractures in elderly patients. Despite a high complication rate, open reduction and internal fixation is the gold standard for operative care. However, individual patient-based treatment decision considering the soft-tissue status, the fracture pattern, as well as the patient's mobility and comorbidities is mandatory to achieve sufficient patient outcomes. Due to high complication rates after surgery in the past, techniques such as fibular nails or minimal invasive techniques should be considered.
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Affiliation(s)
- Patrick Ziegler
- BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany,Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
| | - Christian Bahrs
- Schön Klinik Neustadt, Neustadt in Holstein, Germany,Correspondence should be addressed to C Bahrs;
| | - Christian Konrads
- Department of Orthopaedic Surgery, University of Tübingen, Tübingen, Germany
| | - Philipp Hemmann
- BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Marc-Daniel Ahrend
- BG Klinik Tübingen, Department of Traumatology and Reconstructive Surgery, Eberhard Karls University of Tübingen, Tübingen, Germany,AO Research Institute Davos, Davos Switzerland
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8
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Surgical timing for torsional ankle fractures is not associated with post-operative complications in patients with type II diabetes mellitus. Arch Orthop Trauma Surg 2022; 142:3889-3894. [PMID: 35083521 DOI: 10.1007/s00402-021-04321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/14/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Surgical stabilization of ankle fractures is one of the most commonly performed procedures in orthopedics, but these injuries can prove difficult to manage in patients with type II diabetes mellitus (DMII). The goal of this study is to determine if a correlation exists between surgical timing and complication rates among diabetic patients with ankle fractures. METHODS This is a retrospective case-control study spanning from 2012 to 2019 including patients with DMII undergoing operative fixation for ankle fractures. The primary independent variable was surgical timing and the primary dependent variable was the rate of post-operative complications. RESULTS The overall complication rate was 25.5% with 60% of these patients requiring repeat surgical intervention. The most common complication was superficial surgical-site infection. There was no significant difference in surgical timing between patients experiencing post-operative complication compared to those who did not. CONCLUSION Among patients with DMII, we failed to show a correlation between surgical timing and post-operative complication.
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Brutico AG, Nasser EM, Brutico JM. Operative Ankle Fractures in Complicated Diabetes: Outcomes of Prolonged Non-Weightbearing. J Foot Ankle Surg 2022; 61:542-550. [PMID: 34794875 DOI: 10.1053/j.jfas.2021.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 02/03/2023]
Abstract
Diabetes increases the risk of developing postoperative complications such as superficial and deep infection, wound dehiscence, and revisional surgery. Prolonged non-weightbearing and/or augmented fixation may reduce postoperative complications in complicated diabetic ankle fractures. This study's purpose was to compare the development of postoperative infection, wound dehiscence, and revisional surgery in complicated diabetic ankle fractures with respect to weightbearing status. We hypothesized that fewer complications would occur in patients with prolonged non-weightbearing. Medical records of 90 surgically treated complicated diabetic ankle fractures were retrospectively reviewed for postoperative radiographs, weightbearing status, and complications. Complicated diabetes was defined as HbA1c ≥ 8% within 1 year of surgery. Twenty-four out of 90 patients had prolonged non-weightbearing status, which was defined as ≥ 8 weeks of non-weightbearing postoperatively. Twelve out of 90 patients had augmented fixation, which was defined as standard open reduction and internal fixation plus ≥ 2 tetra-cortical or > 2 tri-cortical syndesmotic screws with medial plate, external fixation, or other combination. Thirty-three out of 90 patients (36.7%) patients developed complications postoperatively. Patients with prolonged non-weightbearing had less complications (29.2% vs 39.4%, p = .37) and larger HbA1c values compared with early weightbearing patients (10.0 vs 9.3, p = .04). A one-unit increase in creatinine value (mg/dL) revealed a 3.15-fold increase in development of complications (95% confidence interval 1.29-7.65, p = .01). Although not statistically significant, complicated diabetic ankle fractures treated with prolonged non-weightbearing had less complications postoperatively except for ankle Charcot. Creatinine can be utilized as an independent risk factor for postoperative complications in this population.
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Affiliation(s)
- Anthony G Brutico
- Principal Investigator, Regional Foot and Ankle Center, Dunmore, PA.
| | - Ellianne M Nasser
- Secondary Investigator, Geisinger Community Medical Center, Scranton, PA
| | - Joseph M Brutico
- Tertiary Investigator, Geisinger Commonwealth School of Medicine, Clarks Summit, PA
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Galanopoulos IP, Stavlas P, Voyaki SM, Psarakis SA. Ankle Fractures in Diabetic Patients: Report of Two Cases. Cureus 2021; 13:e13519. [PMID: 33786226 PMCID: PMC7994030 DOI: 10.7759/cureus.13519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although ankle fractures are very common cases for orthopedic surgeons with an easy diagnosis and very good outcomes either with conservative or with operative treatment, in diabetic patients, these fractures can be complex with difficult solutions. We report two cases with ankle fractures in diabetic patients from our department with demanding diagnostic or therapeutic approaches and poor outcomes. The first case, a 65-year-old man with undiagnosed diabetes mellitus and neglected ankle fracture dislocation because of diabetic neuropathy, underwent open reduction internal fixation with additional external fixation. Early after the operation, he presented with pin-tract infection, and later after the operation, he developed osteomyelitis which led to salvage below-knee amputation. In the second case, a 70-year-old woman with diabetes mellitus and severe coexisting medical comorbidities underwent open reduction internal fixation plus external fixation for an acute fracture-dislocation of the left ankle. Early after the operation, she developed ischemic lesions of the toes with worsened status despite the vascular surgeon's instructions. Although a below-knee amputation could be an acceptable choice, she denied it. As a result, systematic complications led to her death. It is very important for surgeons to follow an algorithm when they have to manage ankle injuries in diabetic patients because, in these patients, ankle fractures are very demanding and misdiagnosed cases with difficult treatment algorithms and often poor outcomes.
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Affiliation(s)
| | | | - Sofia M Voyaki
- Department of Internal Medicine, G. Gennimatas Athens General Hospital, Athens, GRC
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Ochman S, Raschke MJ. [Ankle fractures in older patients : What should we do differently?]. Unfallchirurg 2021; 124:200-211. [PMID: 33566120 DOI: 10.1007/s00113-021-00953-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
As a result of the demographic developments ankle fractures in older patients are part of routine trauma surgery. Due to comorbidities, such as diabetes mellitus, reduced bone quality and limited compliance in follow-up treatment, these fractures are prone to complications. The primary goal in the treatment of older patients with ankle fractures is to maintain mobility. In contrast to young patients most fractures are unstable pronation-abduction injuries. In the diagnostics the recognition and optimization of factors influencing the outcome, such as the blood perfusion and the generous use of computed tomography (CT) are recommended. As in the case of younger patients, conservative treatment is reserved for stable fracture forms and, if there are contraindications, should also be initiated in the case of unstable injuries. The choice of approaches is different for surgical treatment, which is adapted to the soft tissues, if necessary minimally invasive and increasingly carried out by a posterolateral approach. The initial transfixation can reduce soft tissue problems. Special surgical techniques and implants that provide a high level of stability, such as dorsal plate positioning, hook plates, angular stable plate systems and intramedullary systems as well as additional options, such as tibia pro fibula constructs are used. Primary retrograde nail arthrodesis is reserved as a salvage procedure only for exceptional cases. As part of the follow-up treatment, an interdisciplinary approach with respect for and optimization of concomitant diseases seems to make sense.
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Affiliation(s)
- Sabine Ochman
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland.
| | - Michael J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert Schweitzer Campus 1, Gebäude W1, Waldeyerstr. 1, 48149, Münster, Deutschland
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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
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Affiliation(s)
| | - Hesham Oshba
- Frimley Health NHS Foundation Trust, Frimley Park Hospital, Frimley, UK
| | | | | | - Alexander Wee
- Frimley Health NHS Foundation Trust, Frimley Park Hospital, Frimley, UK
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Grote CW, Tucker W, Stumpff K, Birt MC, Horton GA. Primary Arthrodesis for Diabetic Ankle Fractures. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420908841. [PMID: 35097368 PMCID: PMC8697300 DOI: 10.1177/2473011420908841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Treatment of ankle fractures in patients with diabetes is associated with increased complication rates. Ankle arthrodesis is considered a salvage procedure after failed ankle fracture fixation, yet primary ankle arthrodesis has been proposed as a treatment option for patients with significant diabetes-related complications. To date, the characteristics of patients who undergo primary ankle arthrodesis and the associated outcomes have not been described. Methods A retrospective review was performed of 13 patients with diabetes who underwent primary arthrodesis for traumatic ankle fracture. Patient demographics were characterized in addition to their diabetes complications, Adelaide Fracture in the Diabetic Ankle (AFDA) score, and fracture type. Outcomes assessed included reoperation rates, infection rates, wound complications, nonunion/malunion, amputation, and development of Charcot arthropathy postoperatively. Results Patients who underwent primary arthrodesis had high rates of diabetes complications, average AFDA scores of 6.4, and high rates of severe injuries, including 38.5% open fractures and 69.2% fracture dislocations. The overall complication rate for primary arthrodesis of ankle fractures in diabetes patients was more than 75% in this cohort. Complications included a 38.5% reoperation rate, 38.5% infection rate, 53.8% wound complication rate, and 23.1% amputation rate. Despite a high nonunion rate at the attempted fusion sites, 89.9% of fractures healed and patients had a stable extremity. Conclusion This review is the first to characterize the epidemiology and complications of diabetes patients undergoing primary ankle arthrodesis for ankle fractures. In this cohort, patients with multiple diabetic complications and severe injuries underwent primary arthrodesis, which led to an overall high complication rate. Further research is needed to determine the appropriate treatment option for these high-risk patients, and tibiotalocalcaneal stabilization without arthrodesis may be beneficial. Level of Evidence Level IV, retrospective case series.
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Affiliation(s)
- Caleb W Grote
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - William Tucker
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kelly Stumpff
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mitchell C Birt
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Greg A Horton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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