Haddix Kevin P, Clement R Carter, Tennant Joshua N, Ostrum Robert F
UNC Orthopaedics, Chapel Hill, North Carolina.
Foot Ankle Spec. 2018 Jun;11(3):206-216. doi: 10.1177/1938640017714867. Epub 2017 Jun 15.
Diabetics with ankle fractures experience more complications than the general population, but it is unclear whether complications differ between type 1 and 2 diabetics and between insulin- and non-insulin-dependent diabetics. This study aims to determine if there is a difference in postoperative complication rates between these groups.
An administrative health care database from a large commercial insurer was queried to identify operatively treated ankle fractures in patients with type 1 (T1D), type 2 (T2D), type 2 insulin-dependent (T2ID), and type 2 non-insulin-dependent (T2NID) diabetes. Postoperative complications were identified to include postoperative stiffness, posttraumatic arthritis, amputation, implant removal, and infection. Subgroup analysis was performed to control for comorbidities.
A total of 20 703 closed and 2873 open operatively treated ankle fractures were identified. Patients with T1D experienced higher rates of amputation, postoperative infection, and total complications than patients with T2D (P < .05). Patients with T2ID experienced higher rates of amputation, infection, and total complications than those with T2NID (P < .0001). Subgroup analysis controlling for comorbidities showed a higher total complication rate for T1D compared with T2D in closed ankle fractures (P < .02) and for T2ID compared with T2NID in both open and closed ankle fractures (P < .0001).
Patients with T1D and T2ID have higher complication rates than patients with T2D and T2NID, respectively. Foot and ankle surgeons should be cautioned not to classify diabetics as one cohort and should use these findings to stratify risk among this patient population.
Level III: Diagnostic.
与普通人群相比，患有踝关节骨折的糖尿病患者会经历更多并发症，但尚不清楚1型和2型糖尿病患者之间以及胰岛素依赖型和非胰岛素依赖型糖尿病患者之间的并发症是否存在差异。本研究旨在确定这些组之间术后并发症发生率是否存在差异。
查询一家大型商业保险公司的行政医疗保健数据库，以识别1型糖尿病（T1D）、2型糖尿病（T2D）、2型胰岛素依赖型糖尿病（T2ID）和2型非胰岛素依赖型糖尿病（T2NID）患者接受手术治疗的踝关节骨折情况。确定术后并发症包括术后僵硬、创伤后关节炎、截肢、植入物取出和感染。进行亚组分析以控制合并症。
共识别出20703例闭合性和2873例开放性手术治疗的踝关节骨折。与T2D患者相比，T1D患者的截肢率、术后感染率和总并发症发生率更高（P < 0.05）。与T2NID患者相比，T2ID患者的截肢率、感染率和总并发症发生率更高（P < 0.0001）。控制合并症的亚组分析显示，在闭合性踝关节骨折中，T1D患者的总并发症发生率高于T2D患者（P < 0.02）；在开放性和闭合性踝关节骨折中，T2ID患者的总并发症发生率均高于T2NID患者（P < 0.0001）。
T1D和T2ID患者的并发症发生率分别高于T2D和T2NID患者。足踝外科医生应注意不要将糖尿病患者归为同一队列，而应利用这些发现对该患者群体的风险进行分层。
三级：诊断性。
