Lovy Andrew J, Dowdell James, Keswani Aakash, Koehler Steven, Kim Jaehon, Weinfeld Steven, Joseph David
1 Mount Sinai Hospital, Department of Orthopaedic Surgery, New York, NY, USA.
2 Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Foot Ankle Int. 2017 Mar;38(3):255-260. doi: 10.1177/1071100716678796. Epub 2016 Nov 14.
Diabetes is a risk factor for complications related to displaced ankle fractures. Limited literature exists comparing complication rates in nonoperative versus operative treatment of displaced ankle fractures in diabetics. No study has highlighted the natural history of nonoperative treatment of displaced ankle fractures in diabetics.
We retrospectively reviewed all adult ankle fractures from September 2011 through December 2014. Inclusion was limited to ambulatory adults (>18 years) with closed, displaced (widened mortise) ankle fractures with diabetes mellitus. Nonoperative treatment consisted of closed reduction and casting. Fractures were classified according to the Lauge-Hansen and AO-Weber classification systems. All operative fractures underwent open reduction internal fixation (ORIF) within 3 weeks of injury. Functional outcomes and complication rates were compared. Of 28 displaced diabetic ankle fractures, 20 were treated nonoperatively (closed reduction and casting) and 8 operatively (ORIF within 3 weeks of injury). Mean follow-up was 7 months (range 3-18 months).
Age, insulin-dependent diabetes, and AO type B fracture rate were similar in nonoperative and operative cohorts, but fracture dislocation rate was significantly higher among operative fractures (87.5% vs 40%; P = .04). Nonoperative treatment was associated with a 21-fold increased odds of complication compared with operative treatment (75% vs 12.5%, OR 21.0, P = .004). Complication rate following unintended ORIF for persistent nonunion or malunion in nonoperatively treated patients was significantly greater compared with immediate ORIF (100% vs 12.5%, P = .005).
Nonoperative treatment of displaced diabetic ankle fractures was associated with unacceptably high complication rates when compared to operative treatment.
Level III, retrospective comparative series.
糖尿病是与踝关节移位骨折相关并发症的一个危险因素。关于糖尿病患者踝关节移位骨折非手术治疗与手术治疗并发症发生率比较的文献有限。尚无研究强调糖尿病患者踝关节移位骨折非手术治疗的自然病程。
我们回顾性分析了2011年9月至2014年12月期间所有成年踝关节骨折病例。纳入标准仅限于患有糖尿病的非卧床成年患者（年龄>18岁），其踝关节骨折为闭合性、移位性（胫距关节增宽）骨折。非手术治疗包括闭合复位和石膏固定。骨折根据Lauge-Hansen和AO-Weber分类系统进行分类。所有手术治疗的骨折均在受伤后3周内接受切开复位内固定（ORIF）。比较功能结果和并发症发生率。在28例糖尿病患者踝关节移位骨折中，20例接受非手术治疗（闭合复位和石膏固定），8例接受手术治疗（受伤后3周内进行ORIF）。平均随访时间为7个月（范围3 - 18个月）。
非手术组和手术组在年龄、胰岛素依赖型糖尿病以及AO B型骨折发生率方面相似，但手术治疗的骨折中骨折脱位率显著更高（87.5%对40%；P = 0.04）。与手术治疗相比，非手术治疗的并发症发生几率增加了21倍（75%对12.5%，OR 21.0，P = 0.004）。与立即进行ORIF相比，非手术治疗患者因持续性骨不连或畸形愈合而意外进行ORIF后的并发症发生率显著更高（100%对12.5%，P = 0.005）。
与手术治疗相比，糖尿病患者踝关节移位骨折的非手术治疗并发症发生率高得令人难以接受。
III级，回顾性比较系列研究。
