Management of Acute Diabetic Fractures of the Ankle

Abstract

Ankle fractures are so commonly seen and routinely treated that we fail to remember that the diabetic patient also presents with impaired healing of the wound and bone, vascular insufficiency, and neuropathy. This is because chronic hyperglycemia increases osteoclastic activity, decreases osteoblastic activity, impairs the ability of the red blood cell to deliver oxygen, and decreases the ability of fibroblasts from migrating and attaching to wounds. Overall, the incidence of adult ankle fractures is 100.8/100,000/per year with approximately 260,000 Americans per year sustaining an ankle, six percent of which are diabetics. Preoperatively, patients should have good neurovascular examinations along with an evaluation of their hemoglobin A_1c. Preoperative evaluation combined with surgical techniques, specific for the diabetic pathology, is presented to provide optimal patient outcome for this patient population. Non-operative treatment is indicated for non-displaced fractures. All displaced fractures should be managed surgically with four options available: standard fixation, trans-syndesmotic, trans-articular or a combined technique. Major complications associated with managing these patients consist of failure of fixation, skin and wound problems, infections and the development of Charcot neuroarthropathy.