Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy.
Department of Physical Medicine and Rehabilitation, Board of Physical Medicine and Rehabilitation, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, "Sapienza" University of Rome, Rome, Italy.
Diabetes Metab Res Rev. 2018 Feb;34(2). doi: 10.1002/dmrr.2954. Epub 2017 Nov 7.
Open reduction and internal fixation is the standard treatment for displaced ankle fractures. However, the presence of comorbidities such as diabetes mellitus and body mass index (BMI) are associated with poor bone quality, and these factors may predict the development of postoperative complications. The study aim was to assess the role of diabetes mellitus and BMI in wound healing in patients younger than 65 years who were surgically treated for malleoli fractures.
Ninety patients, aged from 18 to 65 years old, with surgically treated ankle fracture, were retrospectively enrolled. Patients were classified in two groups: patient with diabetes and patients without diabetes (insulin-dependent and noninsulin dependent). All patients were assessed for wound complications, Visual Analogue Scale and Foot and Ankle Disability Index (FADI) were assessed for all patients. Logistic regression was used to identify the risk of wound complications after surgery using the following factors as explanatory variables: age, gender, duration of surgery, BMI, hypercholesterolemia, smoking history, diabetes mellitus, and high blood pressure.
In total, 38.9% of patients showed wound complications. Of them, 17.1% were nondiabetics and 82.9% were diabetics. We observed a significant association between DM and wound complications after surgery (P = .005). Logistic regression analysis revealed that DM (P < .001) and BMI (P = .03) were associated with wound complications. The odds of having a postoperative wound complication were increased 0.16 times in the presence of diabetes and 1.14 times for increasing BMI.
This study showed that diabetes mellitus and higher BMI delay the wound healing and increase the complication rate in young adult patients with surgically treated bimalleolar fractures.
切开复位内固定是治疗踝关节移位骨折的标准治疗方法。然而，患有糖尿病和身体质量指数（BMI）等合并症会导致骨质量较差，这些因素可能预测术后并发症的发生。本研究旨在评估糖尿病和 BMI 对 65 岁以下接受手术治疗的内踝骨折患者伤口愈合的影响。
回顾性纳入 90 例年龄在 18 至 65 岁之间接受手术治疗的踝关节骨折患者。将患者分为两组：糖尿病患者和非糖尿病患者（胰岛素依赖型和非胰岛素依赖型）。所有患者均评估伤口并发症，所有患者均评估视觉模拟评分和足踝残疾指数（FADI）。使用逻辑回归分析使用以下因素作为解释变量来确定手术后伤口并发症的风险：年龄、性别、手术持续时间、BMI、高胆固醇血症、吸烟史、糖尿病和高血压。
共有 38.9%的患者出现伤口并发症。其中，17.1%是非糖尿病患者，82.9%是糖尿病患者。我们观察到 DM 与手术后伤口并发症之间存在显著关联（P=0.005）。逻辑回归分析显示，DM（P<0.001）和 BMI（P=0.03）与伤口并发症相关。存在糖尿病时，术后发生伤口并发症的几率增加 0.16 倍，BMI 增加 1.14 倍。
本研究表明，糖尿病和较高的 BMI 会延迟年轻成年患者手术治疗双踝骨折的伤口愈合，并增加并发症发生率。
