Costigan William, Thordarson David B, Debnath Ujjwal K
USC Department of Orthopaedic Surgery, Los Angeles, CA 90033, USA.
Foot Ankle Int. 2007 Jan;28(1):32-7. doi: 10.3113/FAI.2007.0006.
Multiple studies have documented increased risks associated with treatment of ankle fractures in patients with diabetes mellitus. We reviewed our results in the largest series to date of this complex patient group to determine the frequency of complications.
Eighty-four patients with diabetes had open reduction and internal fixation using standard fixation techniques for acute, closed ankle fractures. The 51 men and 33 women had an average age was 49.3 (22 to 77) years. The average followup was 4.1 years (11 to 97 months). Seventy-five fractures were closed and nine were open. Thirty-nine patients used insulin and 45 used oral hypoglycemics or diet for control of their diabetes. Diabetic complications, including nephropathy, hypertension, peripheral vascular disease, and neuropathy were evaluated. The management of diabetes, fracture classification, and presence of diabetic complications were assessed with chi-square, ANOVA, and univariate logistic regression to determine the presence of statistical significance for these factors.
Twelve of the 84 patients developed postoperative complications. Ten patients developed infections (eight deep and two superficial). Four of 12 patients with preoperative evidence of peripheral neuropathy developed Charcot arthropathy. Ten of 12 patients who had absent pedal pulses preoperatively developed complications (p<0.0001) and 11 of 12 patients with peripheral neuropathy had complications (p<0.0001). A trend towards complications was noted with nephropathy (two of five patients) and hypertension (nine of 12 patients). Open fractures, insulin dependence, patient age, and fracture classification had no significant effect on outcome.
Most patients with diabetes can undergo open reduction and internal fixation of acute ankle fractures without complications. Patients with absent pedal pulses or peripheral neuropathy are at increased risk for complications.
多项研究记录了糖尿病患者治疗踝关节骨折相关风险增加的情况。我们回顾了迄今为止该复杂患者群体最大系列的研究结果，以确定并发症的发生率。
84例糖尿病患者因急性闭合性踝关节骨折采用标准固定技术进行切开复位内固定。51例男性和33例女性的平均年龄为49.3岁（22至77岁）。平均随访时间为4.1年（11至97个月）。75例骨折为闭合性，9例为开放性。39例患者使用胰岛素，45例使用口服降糖药或通过饮食控制糖尿病。评估糖尿病并发症，包括肾病、高血压、外周血管疾病和神经病变。采用卡方检验、方差分析和单因素逻辑回归评估糖尿病的管理、骨折分类和糖尿病并发症的存在情况，以确定这些因素的统计学意义。
84例患者中有12例发生术后并发症。10例患者发生感染（8例深部感染和2例浅表感染）。术前有外周神经病变证据的12例患者中有4例发生夏科氏关节病。术前足背动脉搏动消失的12例患者中有10例发生并发症（p<0.0001），12例外周神经病变患者中有11例发生并发症（p<0.0001）。肾病（5例患者中的2例）和高血压（12例患者中的9例）有并发症发生的趋势。开放性骨折、胰岛素依赖、患者年龄和骨折分类对结果无显著影响。
大多数糖尿病患者可以进行急性踝关节骨折的切开复位内固定且无并发症。足背动脉搏动消失或有外周神经病变的患者发生并发症的风险增加。
