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J Am Acad Orthop Surg, Vol 16, No 3, March 2008, 159-170.
© 2008 the American Academy of Orthopaedic Surgeons
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Complications of Ankle Fracture in Patients With Diabetes

Saad B. Chaudhary, MD, MBA, Frank A. Liporace, MD, Ankur Gandhi, PhD, Brian G. Donley, MD, Michael S. Pinzur, MD and Sheldon S. Lin, MD

Dr. Chaudhary is Chief Resident, Department of Orthopaedics, New Jersey Medical School, Newark, NJ.

Dr. Liporace is Assistant Professor, Department of Orthopaedics, New Jersey Medical School.

Dr. Gandhi is PhD Candidate, University of Medicine and Dentistry of New Jersey, Newark.

Dr. Donley is Orthopaedic Surgery Staff, the Cleveland Clinic, Cleveland, OH.

Dr. Pinzur is Professor, Department of Orthopaedic Surgery and Rehabilitation, Loyola University, Maywood, IL.

Dr. Lin is Associate Professor, Department of Orthopaedics, New Jersey Medical School, Newark.

Dr. Pinzur or a member of his immediate family has received research or institutional support from DePuy Orthopaedics. Dr. Lin or a member of his immediate family has received research or institutional support from DePuy Acromed and serves as a consultant to or is an employee of Tornier. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Chaudhary, Dr. Liporace, Dr. Gandhi, and Dr. Donley.

Reprint requests: Dr. Lin, University Hospital, 90 Bergen Street, Suite 1200, PO Box 1709, Newark, NJ 07101-1709.

Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.






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Copyright © 2008 by the American Academy of Orthopaedic Surgeons.