Jones KB, Maiers-Yelden KA, Marsh JL, et al: Ankle fractures in patients with diabetes mellitus. J Bone Joint Surg Br 87: 489, 2005.
McCormack RG, Leith JM: Ankle fractures in diabetics: complications of surgical management. J Bone Joint Surg Br 80: 689, 1998.
Low CK, Tan SK: Infection in diabetic patients with ankle fractures. Ann Acad Med Singapore 24: 353, 1995.
Blotter RH, Connolly E, Wasan A, et al: Acute complications in the operative treatment of isolated ankle fractures in patients with diabetes mellitus. Foot Ankle Int 20: 687, 1999.
Connolly JF, Csencsitz TA: Limb threatening neuropathic complications from ankle fractures in patients with diabetes. Clin Orthop Relat Res 348: 212, 1998.
Flynn JM, Rodriguez-del Rio F, Piza PA: Closed ankle fractures in the diabetic patient. Foot Ankle Int 21: 311, 2000.
White CB, Turner NS, Lee G-C, et al: Open ankle fractures in patients with diabetes mellitus. Clin Orthop Relat Res 414: 37, 2003.
Holmes GB Jr, Hill N: Fractures and dislocations of the foot and ankle in diabetics associated with Charcot joint changes. Foot Ankle Int 15: 182, 1994.
Jani MM, Ricci WM, Borrelli J Jr, et al: A protocol for treatment of unstable ankle fractures using transarticular fixation in patients with diabetes mellitus and loss of protective sensibility. Foot Ankle Int 24: 838, 2003.
Costigan W, Thordarson DB, Debnath UK: Operative management of ankle fractures in patients with diabetes mellitus. Foot Ankle Int 28: 32, 2007.
Wukich DK, Joseph A, Ryan M, et al: Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes. Foot Ankle Int 32: 120, 2011.
Lavery LA, Armstrong DG, Murdoch DP, et al: Validation of the Infectious Diseases Society of America's diabetic foot infection classification system. Clin Infect Dis 44: 562, 2007.
Rejnmark L, Vestergaard P, Mosekilde L: Treatment with beta-blockers, ACE inhibitors, and calcium-channel blockers is associated with a reduced fracture risk: a nationwide case-control study. J Hypertens 24: 581, 2006.
Ehrlich HP, Hunt TK: Effects of cortisone and vitamin A on wound healing. Ann Surg 167: 324, 1968.
Assante J, Collins S, Hewer I: Infection associated with single-dose dexamethasone for prevention of postoperative nausea and vomiting: a literature review. AANA J 83: 281, 2015.
Snall J, Apajalahti S, Suominen A-L, et al: Influence of perioperative dexamethasone on delayed union in mandibular fractures: a clinical and radiological study. Med Oral Patol Oral Cir Bucal 20: e621, 2015.
Background: To evaluate complications and risk factors for nonunion in patients with diabetes after ankle fracture.
Methods: We conducted a retrospective study of 139 patients with diabetes and ankle fractures followed for 1 year. We evaluated the incidence of wounds, infections, nonunions, Charcot’s arthropathy, and amputations. We determined Fracture severity (unimalleolar, bimalleolar, trimalleolar), nonunion, and Charcot’s arthropathy from radiographs. Nonunion was defined as a fracture that did not heal within 6 months of fracture. Analysis of variance was used to compare continuous variables, and χ2 tests to compare dichotomous variables, with α = 0.05. Logistic regression was performed with a binary variable representing nonunions as the dependent variable.
Results: Complications were common: nonunion (24.5%), Charcot’s arthropathy (7.9%), wounds (5.2%), wound site infection (17.3%), and leg amputation (2.2%). Patients with nonunions were more likely to be male (55.9% versus 29.5%; P = .005), have sensory neuropathy (76.5% versus 32.4%; P < .001), have end-stage renal disease (17.6% versus 2.9%; P < .001), and use insulin (73.5% versus 40.1%; P < .001), β-blockers (58.8% versus 39.0%; P = .049), and corticosteroids (26.5% versus 9.5%; P = .02). Among patients with nonunion, there was an increased risk of wounds (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.46–7.73), infection (OR, 2.04; 95% CI, 0.72–5.61), amputation (OR, 7.74; 95% CI, 1.01–100.23), and long-term bracing (OR, 9.51; 95% CI, 3.8–23.8). In the logistic regression analysis, four factors were associated with fracture nonunion: dialysis (OR, 7.7; 95% CI, 1.7–35.2), insulin use (OR, 3.3; 95% CI, 1.5–7.4), corticosteroid use (OR, 4.9; 95% CI, 1.4–18.0), and ankle fracture severity (bimalleolar or trimalleolar fracture) (OR, 2.5; 95% CI, 1.1–5.4).
Conclusions: These results demonstrate risk factors for nonunions: dialysis, insulin use, and fracture severity after ankle fracture in patients with diabetes.