Elevated Risks of Ankle Fracture Surgery in Patients With Diabetes

Abstract

A nkle fractures are one of the most common types of injuries treated by orthopedic surgeons. For the majority of patients, results are satisfactory, and most are able to return to their pre-injury level of functioning. However, for a minority, a seemingly straightforward ankle fracture can be devastating, resulting in wound complications, multiple reoperations, and, for some, amputation. Previous studies have shown that certain patients are more likely to suffer from these complications, particularly those with impaired wound healing. Patients predisposed to impaired wound healing may include, among others, those with diabetes or peripheral vascular disease and those taking steroid medications. In today's aging population, diabetes is common and on the rise, making it vital that treatment teams be aware of potential pitfalls in their treatment. The purposes of this study were to determine the rates of wound infection, reoperation, and amputation after surgical treatment of ankle fractures in patients with diabetes and to quantify the increased risk of these complications in a large, diverse patient population. Clarifying the magnitude of risk and the rates of these complications will assist orthopedic surgeons and medical consultants in the treatment and the counseling of patients with these conditions. The strength of this study lies in the large, diverse patient sample, in which multiple races, ages, comorbidities, and provider characteristics are represented. We hypothesized that the risk of wound infection, revision surgery, and amputation after surgical treatment of ankle fractures would be higher in patients with diabetes compared to patients without these conditions. In addition, we hypothesized that patients with complicated diabetes would have a higher risk of these complications compared to both patients without diabetes and those with uncomplicated diabetes. ### Data source Data for all hospital discharges in California in the years 1995–2005 were obtained from California's Office of Statewide Health Planning and Development …