The Management of Ankle Fractures in Diabetics

Abstract

Ankle fractures in diabetics are challenging to treat, and only generalized clinical guidelines specific to their treatment exist. As such, the American Orthopaedic Foot and Ankle Society (AOFAS) membership was polled regarding the management of different types of ankle fractures in this patient population. We developed a multiple-choice survey with 3 clinical scenarios involving diabetic ankle fractures that was sent via e-mail to the 895 active members of the AOFAS. In addition to providing demographic information, respondents identified their preferred stabilization method, the need for supplemental fixation, and each patient's weight-bearing status. Respondents' number of years in practice, number of ankle fractures treated monthly, and type of fellowship training did not correlate with management strategies. Enhanced fixation with syndesmotic screws was advocated in the setting of displaced fractures without syndesmotic injury, while casting was selected as the treatment for those that were nondisplaced. Prolonged periods of non-weight bearing were chosen by survey participants in all cases. We identified several treatment trends among AOFAS membership regarding ankle fractures in diabetics. However, it is pivotal that further investigation evaluate both optimal fixation strategies and the factors that influence surgeon decision making in the setting of diabetic ankle fractures, as the orthopaedic surgeon is encountering such patients more than ever before.