Outcomes of Surgically Treated Pilon Fractures: A Comparison of Patients with and without Diabetes.

Abstract

Compare systemic complications, fracture healing related complications, and reoperation rates for pilon fractures in patients with and without diabetes. Retrospective cohort study. National administrative claims database with patient records. Patients from the years 2016 to 2020 with surgically treated closed or open pilon fractures. Patients with either closed or open pilon fractures with diabetes were compared to those without diabetes. Subgroup analysis was performed on diabetic patients with and without neuropathy. Postoperative systemic complications at 90 days, fracture healing complications at 90 days and 1 year, and reoperative rates at 90 days and 1 year. 2,654 (31.4%) patients with closed fractures and 491 (28.7%) patients with open fractures had a diagnosis of diabetes. In both open and closed fractures, we identified significantly higher rates of acute kidney injury, cardiac arrest, and surgical site infection in diabetic patients compared to non-diabetic patients. Additionally, we found significantly higher rates of below knee amputations in diabetic patients. Diabetic patients with closed fractures had significantly higher rates of wound healing related reoperations. Patients with advanced diabetic disease, as suggested by the presence of neuropathy, had higher rates of nonunions and post-traumatic arthritis. The data presented here provides updated estimates on complication rates in pilon fractures using large sample size. Additionally, our work identifies differences in outcomes for patients with and without diabetes following pilon fracture surgery. Our data suggests that patients with severe diabetes are prone to higher rates of healing complications and may benefit from additional therapeutic support. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.