Principal Investigator, Regional Foot and Ankle Center, Dunmore, PA.
Secondary Investigator, Geisinger Community Medical Center, Scranton, PA.
J Foot Ankle Surg. 2022 May-Jun;61(3):542-550. doi: 10.1053/j.jfas.2021.09.028. Epub 2021 Oct 22.
Diabetes increases the risk of developing postoperative complications such as superficial and deep infection, wound dehiscence, and revisional surgery. Prolonged non-weightbearing and/or augmented fixation may reduce postoperative complications in complicated diabetic ankle fractures. This study's purpose was to compare the development of postoperative infection, wound dehiscence, and revisional surgery in complicated diabetic ankle fractures with respect to weightbearing status. We hypothesized that fewer complications would occur in patients with prolonged non-weightbearing. Medical records of 90 surgically treated complicated diabetic ankle fractures were retrospectively reviewed for postoperative radiographs, weightbearing status, and complications. Complicated diabetes was defined as HbA1c ≥ 8% within 1 year of surgery. Twenty-four out of 90 patients had prolonged non-weightbearing status, which was defined as ≥ 8 weeks of non-weightbearing postoperatively. Twelve out of 90 patients had augmented fixation, which was defined as standard open reduction and internal fixation plus ≥ 2 tetra-cortical or > 2 tri-cortical syndesmotic screws with medial plate, external fixation, or other combination. Thirty-three out of 90 patients (36.7%) patients developed complications postoperatively. Patients with prolonged non-weightbearing had less complications (29.2% vs 39.4%, p = .37) and larger HbA1c values compared with early weightbearing patients (10.0 vs 9.3, p = .04). A one-unit increase in creatinine value (mg/dL) revealed a 3.15-fold increase in development of complications (95% confidence interval 1.29-7.65, p = .01). Although not statistically significant, complicated diabetic ankle fractures treated with prolonged non-weightbearing had less complications postoperatively except for ankle Charcot. Creatinine can be utilized as an independent risk factor for postoperative complications in this population.
糖尿病会增加术后并发症的风险，如浅表和深部感染、伤口裂开和翻修手术。对于复杂的糖尿病踝关节骨折，延长非负重和/或增强固定可能会降低术后并发症的发生风险。本研究旨在比较复杂糖尿病踝关节骨折患者的负重状态与术后感染、伤口裂开和翻修手术的发生情况。我们假设延长非负重时间会减少并发症的发生。回顾性分析了 90 例手术治疗的复杂糖尿病踝关节骨折患者的病历资料，包括术后 X 线片、负重状态和并发症。复杂糖尿病定义为手术前 1 年内 HbA1c≥8%。90 例患者中有 24 例患者采用了延长非负重状态，定义为术后至少 8 周不负重。90 例患者中有 12 例采用了增强固定，定义为标准切开复位内固定加至少 2 个四皮质或>2 个三皮质踝关节联合螺钉加内侧钢板、外固定或其他组合。90 例患者中有 33 例（36.7%）患者术后出现并发症。与早期负重患者相比，采用延长非负重状态的患者并发症发生率较低（29.2%比 39.4%，p=0.37），且糖化血红蛋白（HbA1c）值更高（10.0 比 9.3，p=0.04）。肌酐值（mg/dL）每增加 1 个单位，并发症的发生风险增加 3.15 倍（95%置信区间 1.29-7.65，p=0.01）。虽然没有统计学意义，但除了踝关节夏科氏关节外，采用延长非负重状态治疗的复杂糖尿病踝关节骨折患者术后并发症发生率较低。在该人群中，肌酐可作为术后并发症的独立危险因素。
