Fractures In Diabetic Patients Research Articles

Evaluation of arthroscopic ankle fusion for diabetic ankle fractures

Background Ankle fractures are a very common orthopedic trauma. One in eight patients undergoing ankle fixation is diabetic. Most of these patients also have additional comorbidities including peripheral arterial disease and diabetic neuropathy. Therefore, on one hand surgical intervention can pose challenges for wound healing and risk of infection, but non-operative management increases the risk for loss of reduction and therefore stresses the condition of the surrounding soft tissue. The aim of this work was to observe the radiological and functional outcome of arthroscopic ankle fusion in diabetic ankle fractures. Methods This prospective study was carried out on 20 patients, both sexes, with clinical criteria of displaced ankle fractures in diabetics, adults, closed ankle fractures, isolated trauma, diabetic patients with neuropathy and Adelaide Fracture in the Diabetic Ankle score more than or equal 5. Results Fourteen cases had solid bony union at a mean of 27.2 weeks while six cases had stable ankles with stiff fibrous nonunion at the end of the follow up period. Two of which had a breakage of distal locking screws. However, stiff fibrous nonunion of tibio-talar joint with the foot in a stable plantigrade position was considered satisfactory and no further intervention was advised. Our limb salvage rate was 100%. No below knee amputation was done. Conclusions Ankle fractures in diabetic patients are increasingly frequently encountered in comorbid patients with suboptimal overlying soft tissue integrity. Arthroscopic assisted ankle fusion can be considered a valid primary definitive treatment option to help reduce the potential perioperative soft tissue insult and associated complications. Utilizing an arthroscopic-assisted approach to this procedure is of added benefit in allowing for articular preparation and thereby reducing the risk of non-union while also minimizing additional extensive soft tissue insult in patients with underlying soft tissue compromise.

Potential Metabolic Pathways Involved in Osteoporosis and Evaluation of Fracture Risk in Individuals with Diabetes.

Diabetes has a significant global prevalence. Chronic hyperglycemia affects multiple organs and tissues, including bones. A large number of diabetic patients develop osteoporosis; however, the precise relationship between diabetes and osteoporosis remains incompletely elucidated. The activation of the AGE-RAGE signaling pathway hinders the differentiation of osteoblasts and weakens the process of bone formation due to the presence of advanced glycation end products. High glucose environment can induce ferroptosis of osteoblasts and then develop osteoporosis. Hyperglycemia also suppresses the secretion of sex hormones, and the reduction of testosterone is difficult to effectively maintain bone mineral density. As diabetes therapy, thiazolidinediones control blood glucose by activating PPAR-γ. Activated PPAR-γ can promote osteoclast differentiation and regulate osteoblast function, triggering osteoporosis. The effects of metformin and insulin on bone are currently controversial. Currently, there are no appropriate tools available for assessing the risk of fractures in diabetic patients, despite the fact that the occurrence of osteoporotic fractures is considerably greater in diabetic individuals compared to those without diabetes. Further improving the inclusion criteria of FRAX risk factors and clarifying the early occurrence of osteoporosis sites unique to diabetic patients may be an effective way to diagnose and treat diabetic osteoporosis and reduce the risk of fracture occurrence.

Effect of Elevated Blood Glucose on Postoperative Complications Among Diabetic Patients After Surgical Treatment of Torsional Ankle Fracture.

This study aims to evaluate the association of elevated blood glucose and postoperative complications among diabetic patients after surgical treatment of torsional ankle fracture. This was a retrospective study of consecutive diabetic patients treated surgically for a torsional ankle injury between January 2017 and December 2021 at a large tertiary hospital. All patients who met inclusion and exclusion criteria were divided into a high-HbA1c group or a low-HbA1c group according to the HbA1c cutoff of 7.0% within 3 months of operation, then a propensity score match was performed to control potential confounding factors. The primary outcomes were postoperative complications, and secondary outcomes were unplanned secondary procedures. A matched cohort of 238 patients was finally included, with 119 patients with high HbA1c levels and 119 with low HbA1c levels. Patients with high HbA1c levels experienced more complications (31.1% vs 18.5%, P < .01) and more secondary procedures (22.7% and 8.4%, P < .01) than those with low HbA1c levels. Multivariate logistic regression indicated that patients with high HbA1c levels were significantly associated with higher proportions of any complications (OR 2.25, 95% CI 1.08-4.69; P = .03), superficial infection (OR 4.03, 95% CI 2.13-5.41; P < .01), deep infection (OR 1.42, 95% CI 1.23-2.02; P < .01), and any unplanned secondary operations (OR 3.72, 95% CI 1.62-8.52; P < .01) compared with those with low HbA1c levels after controlling for potential confounders. Multivariate linear regression showed that high HbA1c levels were significantly associated with a higher number of complications (β = 4.61, 95% CI 2.63-18.18; P < .01) and a higher number of secondary procedures (β = 4.44, 95% CI 2.79-10.87; P < .01). Patients with an HbA1c >7.0% within 3 months of operation are more likely to have a wound issue/infection and more likely to undergo a secondary procedure after surgical treatment of torsional ankle fractures in diabetic patients than patients with an HbA1c ≤7.0% within 3 months of operation.

Comparison of Operative vs Non-operative Management of Ankle Fractures in Diabetic Patients: Prospective Randomized Trial

This study investigates the outcomes and complications associated with the management of ankle fractures in diabetic patients. A total of 44 diabetic patients with ankle fractures were enrolled, and they were randomly assigned to either conservative or operative treatment groups. The study evaluated demographic characteristics, diagnosis, complications, functional outcomes, and correlation with HbA1c and ankle brachial index. The results revealed a 29.5% complication rate among the patients, including superficial infections, Charcot neuroarthropathy, arthritic changes, loss of reduction leading to ankle fusion, and stiffness. Functional outcome scores (AOFAS and SF36) did not significantly differ between the conservative and operative groups. Correlation analysis showed a significant negative relationship between HbA1c levels and functional scores in the conservative group. Ankle brachial index demonstrated a negative correlation with the SF36 score in the conservative treatment group. The study emphasizes the importance of diabetic control and vascular assessment in guiding treatment decisions for diabetic ankle fractures.

An update on the role of antihyperglycemic agents in diabetoporosis

Abstract Diabetes mellitus is a chronic disorder that progresses globally at an alarming rate. The impact of this disorder is severe as it deteriorates the quality of life due to its associated diseases such as kidney disease, cardiovascular disease, obesity, and neurological disorders and also disturbs bone metabolism. One of the major complications of diabetes is osteoporosis, which is frequently brought on by diabetes. Bone abnormalities and a higher risk of fractures are linked to both type type-1 diabetes and type-2 diabetes and hence diabetes is regarded as one of the risk factors for the occurrence of osteoporosis. In view of this, there is a need to assess the therapeutic role of hypoglycemic agents in the treatment of osteoporosis. Glucagon-like peptide-1 (GLP-1) agonist, a hypoglycemic class could be a novel and promising drug target in the management of osteoporosis due to its additional role in the bone remodeling process. It has also been reported that GLP-1 agonists can increase bone mineral density, improve bone quality, and prevent fractures in diabetic patients. This review highlights the recent findings by which antidiabetic medications are used in the treatment of diabetes-induced osteoporosis and also gives an insight into its pathophysiology and possible mechanisms that are involved in the treatment of diabetes-induced osteoporosis. However, more research is required to fully understand the therapeutic role and unique mechanism of GLP-1 agonists in the bone remodeling process.

Study of Functional Outcomes and Complications of Internal Fixation of Pott's Ankle Fractures in Diabetic Patients

Study of Functional Outcomes and Complications of Internal Fixation of Pott's Ankle Fractures in Diabetic Patients

The use of metformin, sulfonylurea compounds and insulin and the risk of hip fractures in diabetic patients: a systematic review and meta-analysis of observational studies

BackgroundHip fracture is a major health problem that occurs more often in the elderly, especially in diabetic patients. Some studies have been conducted regarding the effect of anti- diabetic drugs on fractures. But so far, no meta-analysis study has been conducted to investigate the effect of diabetic drugs on hip fractures. Therefore, this study investigated the relationship between anti-diabetic drugs (Metformin, Sulfonylurea, and insulin) with hip fractures.MethodsIn this systematic review and meta analysis study, PubMed, Scopus, Google Scholar, and Web of Science databases were searched with specific keywords to find relevant studies. Two researchers included related studies after screening based on the title and full text. Cochran’s Q and I2 tests were used to assess heterogeneity between studies. Publication bias between studies was evaluated for each drug using Egger’s test. A 95% confidence interval was used for effect size significance. Overall, 49 studies, including 6,631,297 participants, were reviewed.ResultsThe results showed that metformin significantly reduced the risk of hip fracture (HR: 0.833, 95% CI: 0.759, 0.914, P:0.001). Consumption of sulfonylurea compounds was significantly associated with an increased risk of hip fracture. (HR: 1.175, 95% CI:1.068,1.293, P:0.001), The risk of hip fracture in patients receiving insulin was significantly higher than in diabetic patients who did not receive insulin. (HR:1.366, 95% CI:1.226,1.522, P:0.001).ConclusionThe results of this study showed that taking metformin reduces the risk of hip fracture, and insulin and Sulfonylurea increase the risk of hip fracture.

Successful Primary Treatment of Ankle Fractures in Diabetic Patients with Peripheral Neuropathy Using a Tibiotalocalcaneal Nail: A Case Series.

Among diabetics, patients with peripheral neuropathy are at increased risk of developing complications following an ankle fracture. While the outcomes in these patients treated nonoperatively have been poor, the outcomes in those undergoing open reduction and internal fixation are at the best modest. We hypothesize that closed reduction and internal fixation with tibiotalocalcaneal nail is an effective primary procedure in this complication prone patient group. A retrospective review of diabetic patients with peripheral neuropathy who underwent acute treatment of an ankle fracture with closed reduction and internal fixation with a tibiotalocalcaneal nail at two Level 1 trauma centers was performed. 30 patients were identified and divided into 2 groups with respect to their postoperative weight bearing protocol: 20 patients in the early weight bearing (EWB) group and 10 patients in the touch-down weight bearing (TDWB). The primary outcome was the rate of return to baseline function and the secondary outcomes included the incidence of wound dehiscence, wound infection, implant failure, loss of fixation, loss of reduction and amputation. In the EWB group, 15/20 patients returned to their baseline function, 5/20 had wound dehiscence and infection, 2/20 had implant failure, 5/20 had loss of fixation, 4/20 had loss of reduction, and 4/20 underwent amputation. In the TDWB group, 9/10 patients returned to their baseline function, 1/10 had implant failure, 1/10 had loss of fixation. No patients from this group had loss of reduction or underwent amputation. Treatment with tibiotalocalcaneal nail is an effective primary procedure in this complication prone group of patients, assuming that weight bearing is delayed for six weeks to protect soft tissues and surgical incisions. Level IV, retrospective case series.

Ankle Fractures in Diabetic Patients

Patients with diabetes are at higher risk for complications after surgical fixation of unstable fractures due to impaired neurovascular functioning and wound-healing capabilities. Patients with uncontrolled diabetes have higher rates of complications when compared with patients with controlled diabetes. Despite higher rates of complications, operative fixation of unstable ankle fractures in diabetic patients reliably leads to a functional lower extremity with an overall lower rate of complications than nonoperative management. Operatively and nonoperatively managed ankle fractures in patients with diabetes should remain non-weight-bearing for an extended period of time. Discussion of risk of poor outcomes including deep infection, loss of reduction, return to the operating room, and risk of arthrodesis or amputation should be explicitly discussed with patients and families when managing unstable ankle fractures in diabetic patients.

Comparison of Diabetic and Non-Diabetic Individuals Outcomes Following Ankle ORIF Surgery Based on Physical Therapy Start Times

Category: Ankle; Trauma Introduction/Purpose: The surgical correction of ankle fractures are one of the most common orthopedic procedures performed and about 13% of individuals undergoing these procedure are classified as diabetic. Diabetes, as a disease, impairs fracture healing due to decreased bone quality and cardiometabolic dysfunction. The use of early mobilization following ankle surSgery has improved post-operative outcomes in the 'healthy' populations; however, early mobilization or early physical therapy initiation in the diabetic populations has not been elucidated. Methods: Surgical correction CPT codes for ankle fracture were used to identify eligible patients followed by a retrospective chart review to confirm diagnosis and procedure(s) as well as collection of demographic information and pertinent medical history. Patient cases were examined over a two year period. Once the inclusion criteria was met, 209 unique patients were included in the analyses. Patients were grouped by diabetes status and early (i.e., &lt;=8 weeks) or late mobilization (i.e., days post- op until physical therapy referral). Generalized linear models and a series Chi-squared tests, Fisher's Exact tests, one-way ANOVAs, and Mann Whitney U Tests were used to assess recovery duration, fracture healing, time to PT referral, medical history, and demographic information. Results: The diabetic group in our study was significantly older [60 (IQR:18) vs. 58 (26) years; p = 0.019] and had a higher BMI [34(8) vs. 29(10); p = 0.041] compared to our non-diabetic group but there were no differences in the proportions for sex or the fracture type by diabetic status. The non-diabetic group displayed a quicker fracture healing time [86(35) vs. 111(45) days; p = 0.04] but there were no differences in recovery duration or days until physical therapy was prescribed. The GLM analysis performed with recovery duration (i.e., time to medical clearance) found that late mobilization was a significant predictor (p &lt; 0.001) of recovery duration but not diabetic diagnosis (p = 0.738). Conclusion: There appears to be a different demographic profile for diabetic patients experiencing an ankle fracture when compared to non-diabetic patients. The delay in physical therapy referral and presumably early mobilization appears to be the strongest predictor of recovery duration. Future research should utilize randomized controlled trials to determine if early mobilization is safe and effective at facilitating quicker fracture healing and recovery following the surgical correction of an ankle fracture in diabetic patients.

Genetic impact of vitamin D receptor TaqI polymorphism on the risk of osteoporotic fractures in diabetic patients

The influence of vitamin D receptor (VDR) gene and the risk of fractures especially osteoporotic fractures remain to be elucidated in Egyptian adult male population. Therefore, this case control study aimed to investigate the linkage between VDR gene polymorphism, primary idiopathic osteoporotic fractures and secondary type 2 diabetes mellitus (T2DM) osteoporotic fractures. Hence, VDR TaqI gene rs731236 polymorphism is assessed with real time polymerase chain reaction (PCR). Moreover, bone mineral density (BMD), fasting plasma glucose (FPG) and serum 25-OH vitamin D, albumin, total calcium and ionized calcium were measured. The results revealed that VDR TaqI, the recessive genotype, GG (tt) is predominant in healthy participants over primary idiopathic osteoporotic fractures and secondary T2DM osteoporotic fractures. Moreover, AG (Tt) genotype was significantly found in secondary T2DM osteoporotic fractures compared to primary idiopathic osteoporotic fractures.Therefore, VDR TaqI GG (tt) genotype, proved its protective role against primary osteoporotic fractures and secondary T2DM osteoporotic fractures. Moreover, the heterozygous genotype, AG (Tt) is predominant in the secondary T2DM osteoporotic fractures. Hence, A (T) allele in T2DM patients may contribute to osteoporotic fractures.

Current concepts and challenges in managing ankle fractures in the presence of diabetes: A systematic review of the literature

BackgroundAnkle fractures in diabetic patients are known to have an increased morbidity. This systematic review aims to evaluate the current evidence in terms of risk profile and inform treatment options. MethodsFollowing the methodology of the Cochrane collaboration, an extensive literature search was conducted. Outcomes included, complications, operative and non-operative management and early weight-bearing. ResultsA total of 40 studies were included. Complication rates were higher in diabetic patients and more so in poorly controlled diabetes, IDDM, or “complicated” diabetes. Supplementary fixation was associated with lower complication rates. Regarding early weight-bearing, similar results to non-diabetics in the stable fracture pattern were found providing there was no evidence of neuropathy. ConclusionDiabetes, especially complicated diabetes, presents an increased risk of complications. However non operative management of diabetic ankle fractures do poorly, and with the use of ‘ORIF plus’ techniques there is no increase in complications from early fixation. The use of external fixation for definitive fixation should be minimised as it is associated with high complication rates.

Diabetic ankle fracture complications: a meta-analysis

IntroductionThis meta-analysis aimed to review complication rates following the treatment of an ankle fracture in diabetic patients and to early detect the subgroup of patients at potential risk in order to minimise this complication rate. MethodsA search of 3 databases was performed for studies published till March 2018. Twelve studies met the eligibility criteria for further statistical analysis. An odds ratio (OR) with a 95% confidence interval (95% CI) for each complication was calculated between the diabetic and non-diabetic groups. ResultsThe overall complication risk after ankle fracture was twice as high in diabetes mellitus (DM) than non-diabetes mellitus (non-DM) patients (OR 1.9, 95%CI: 1.7–2.03). This risk was considerably higher with surgery versus non-surgical treatment (OD 3.7, 95%CI: 2.3–6.2). The risk of infection was 3 times higher in DM than in non-DM patients (OR 3.4, 95%CI: 2.9–9.8). The complication rate was even higher in patients with advanced DM (OR 8.4, 95%CI: 2.9–24.5). ConclusionThis meta-analysis provides evidence that diabetic patients are at a greater risk of complication after an ankle fracture.

Distal Radius Fractures in Diabetic Patients: An Analysis of Surgical Timing and Other Factors That Affect Complication Rate.

While not studied for distal radius fractures, the effect of surgical timing on complication rate has been extensively analyzed in the treatment of pilon fractures. The primary aim of this study was to identify any effect surgical timing has on postoperative complication rates after surgical fixation of distal radius fractures in diabetic patients. All patients who underwent surgical fixation of distal radius fractures at a single suburban academic hospital between 2012 and 2019 were reviewed. For each patient, demographics, comorbidities, injury details, fixation method, and postoperative complications were noted. The effect surgical delay, among other factors, had on complication rate in diabetic and nondiabetic patients was explored. Overall, 124 diabetic and 371 nondiabetic distal radius fractures were included. While diabetics had a statistically higher rate of total complications (21.0 vs. 13.5%, P = .045) but similar major complications requiring surgery (P = .12), there was no difference in surgical delay between groups among patients who had total (P = .31) or major (P = .69) complications. Surgical timing was not a risk factor for total (P = .50) or major complications (P = .32) in diabetic fracture bivariate or multivariate analysis. Only younger age and higher energy injuries were significant risk factors for total complications in bivariate (P = .02, P = .03) and multivariate (P = .04, P < .05) analysis. Complication rates after surgically stabilized distal radius fractures in diabetic patients are higher than in nondiabetic patients. However, this rate is not affected by surgical timing. Instead, surgeons should consider factors such as diabetic control in an effort to maximize outcomes and decrease complications. Prognostic Level III.

A Multi-Functional Implant Induces Bone Formation in a Diabetic Model.

Patients with diabetes mellitus (DM) have defective healing of bone fractures. It was previously shown that nonviral gene delivery of plasmid DNA (pDNA) that independently encodes bone morphogenetic protein-2 (BMP-2) and fibroblast growth factor-2 (FGF-2), acts synergistically to promote bone regeneration in a DM animal model. Additionally, both insulin (INS) and the hormonally active form of vitamin D3, 1α,25-dihydroxyvitamin D3 (1α,25(OH)2 D3 ) (VD3) have independently been shown to play key roles in regulating bone fracture healing in DM patients. However, these individual therapies fail to adequately stimulate bone regeneration, illustrating a need for novel treatment of bone fractures in diabetic patients. Here, the ability of local delivery of INS and VD3 along with BMP-2 and FGF-2 genes is investigated to promote bone formation ectopically in Type-2 diabetic rats. A composite consisting of VD3 and INS is developed that contains poly(lactic-co-glycolic acid) microparticles (MPs) embedded in a fibrin gel surrounded by a collagen matrix that is permeated with polyethylenimine (PEI)-(pBMP-2+pFGF-2) nanoplexes. Using a submuscular osteoinduction model, it is demonstrated that local delivery of INS, VD3, and PEI-(pBMP-2+pFGF-2) significantly improves bone generation compared to other treatments, thusimplicating this approach as a method to promote bone regeneration in DM patients with bone fractures.

Ankle fractures in diabetic patients

Surgical complications are more common in patients with complicated diabetes (presence of inner organ failure, neuropathy).Of all patients undergoing ankle fracture fixation, approximately 13% are diabetic and 2% have complicated diabetes mellitus.Non-operative management of ankle fractures in patients with complicated diabetes results in an even higher rate of complications.Insufficient stability of ankle fractures (treated operatively, or non-operatively) can trigger Charcot neuroarthropathy, and result in bone loss, deformity, ulceration, and the need for amputation.Rigid fixation is recommended. Hindfoot arthrodesis (as primary procedure or after failed ankle fracture management) can salvage the limb in approximately 80% of patients.Early protected weight bearing can be allowed, provided rigid fixation without deformity has been achieved.Cite this article: EFORT Open Rev 2020;5:457-463. DOI: 10.1302/2058-5241.5.200025

Abstract #798586: End Stage Renal Disease and Osteoporotic Fractures In Diabetic Patients: A Nationwide Study

Abstract #798586: End Stage Renal Disease and Osteoporotic Fractures In Diabetic Patients: A Nationwide Study

PO 18251 - Functional clinical outcome of the conservative treatment of calcaneal fractures in patients with diabetic neuropathy

Introduction: Calcaneal fractures are potentially serious in diabetic patients with foot insensitivity. The consensus is that surgical treatment involves a high risk of complications in these cases, and conservative treatment is the option of choice because it allows monitoring of the onset of pressure ulcers and the degree of hindfoot collapse, which usually occurs as Charcot arthropathy progresses. Objective: To retrospectively evaluate the mid-term functional clinical outcome of conservative treatment of calcaneal fractures in diabetic patients with advanced peripheral neuropathy associated with loss of protective foot sensitivity. Methods: Fifteen patients (16 feet), 12 men and 3 women, whose mean age at the time of the calcaneal fracture was 53 years (ranging from 34 to 70 years) were retrospectively evaluated after conservative treatment with total contact casting. We considered a functional clinical outcome good when the foot was plantigrade and ulcer-free and the patient could wear deep footwear with custom-made insoles for insensitive feet. The outcome was considered acceptable when the patient had residual deformity requiring custom-made polypropylene ankle-foot orthosis (AFO) braces. The outcome was considered poor when extremity amputation was required, when the patient was unable to bear weight on the foot during gait due to hindfoot instability as a result of the fracture, or when the patient showed recurrent ulcer due to bone prominence resulting from fracture malunion. Results: After a mean follow-up time of 40 months (ranging from 12 to 168 months), we assessed a good outcome in 10 feet, an acceptable outcome in 2 feet with braceable residual deformity, and a poor outcome in 4 feet, 3 of which had recurrent ulcers in the foot support area and another that required amputation due to severe infection. Conclusion: Conservative treatment with total contact casting efficiently produced plantigrade, shoeable or braceable feet without pressure ulcers in approximately two-thirds of our small series of patients with diabetic foot insensitivity who suffered calcaneal fracture.

Diabetic Ankle Fracture Complications: A Meta-Analysis

Category:Ankle, Diabetes, TraumaIntroduction/Purpose:Fractures in diabetic patients have a well-known increased risk of complications and this makes the decision to treat these fractures either surgically or conservatively a difficult choice. However, ankle fractures are mostly treated surgically because of their pattern and the postoperative management does not differ from those ankle fractures in non-diabetic patients.The following study aims to review the evident rate of complications following the treatment of an ankle fracture in diabetic patients and their matched controls.Methods:Searches of PubMed, Scopus, Cochrane and ISI Web of Knowledge were performed for studies published between the date of database inception and March 2018. An initial selection of 202 abstracts was performed by at least 2 different reviewers, of which 77 articles were selected to complete review. After following strict inclusion and exclusion criteria, only 17 papers were admitted to the final meta-analysis.Demographics patient characteristics and incidence of the overall and specific complications were extracted from each study selected and an odds ratio with a 95% confidence interval of each complication was calculated between the diabetic and non- diabetic groups.Major complications (infection, non-union, malunion, Charcot neuroarthropathy, amputation, death) were compared not only between the two main groups but also between subgroups (complicated diabetic and non-complicated diabetic patients, surgical and orthopaedic treatment).The statistics data was analysed by Stata 15.Results:There is a significant increased rate of complications after treating an ankle fracture orthopaedically or surgically in diabetic patients (OR 1.74, IC 95% 1.67 to 1.82). This risk is considerably higher when the ankle fracture is treated surgically (OR 5.14, IC 95% 2.79 -9.58). Among the complications in diabetic patients, the rate is greater in complicated diabetic patients (neuropathy, vasculopathy) compared to the non-complicated diabetic patients (OR 8, IC 95% 2.61 - 26.31).The main complication postoperative in ankle fracture described is infection, which is 7 times higher in diabetic patients in comparison to non-diabetic patients (OR 6.9, IC 95% 3.03 -15.73). The risk of amputation and/or non-union after an ankle fracture in diabetic patients is about 0.2%.Conclusion:This meta-analysis provides evidence that diabetic patients have a significant greater risk of presenting a complication after an ankle fracture. The rate of major complications (infection, malunion, non-union, amputation and death) is by far significantly higher among those diabetic patients treated surgically and even greater among complicated diabetic patients.

Effects of Chronic Kidney Disease on Hemiarthroplasty Outcomes for Fragility Hip Fracture in Diabetic Patients: A Nationwide Population-Based Observational Study

BackgroundThe aim of this study is to compare perioperative outcomes, readmission, and mortality after hemiarthroplasty for hip fractures in diabetic patients with different renal function statuses. MethodsIn this retrospective population-based cohort study, diabetic patients who received primary hemiarthroplasty for hip fracture between January 1997 and December 2013 were identified from the Taiwan National Health Insurance Research Database. Primary outcomes were perioperative outcomes including infection and revision. Secondary outcomes were all-cause readmission and mortality. ResultsA total of 29,535 diabetic patients were included: 8270 patients had chronic kidney disease (CKD group), 1311 patients underwent permanent dialysis (dialysis group), and 19,954 patients did not have CKD (non-CKD group). During a mean follow-up of 4.5 years, these 3 groups had comparable risks of any infection, including superficial and deep infection. Dialysis patients had a significantly higher risk of revision than did CKD and non-CKD patients (subdistribution hazard ratio 1.65, 95% confidence interval 1.16-2.36; subdistribution hazard ratio 1.57, 95% confidence interval 1.10-2.24, respectively). Compared with the non-CKD group, the dialysis group had significantly higher risks of readmission and mortality at all time points, namely 3 months after surgery, 1 year after surgery, and the final follow-up. The CKD group also had higher risks of readmission and mortality than did the non-CKD group at all time points. ConclusionCKD is associated with poor outcomes following hemiarthroplasty for fragility hip fracture. CKD patients may have higher risks of surgical complications including revision than non-CKD patients, and they have significantly elevated risks of readmission and mortality.