Goldberg Ellen M, Polachek William S, Hynes Kelly
University of Chicago Pritzker School of Medicine, Chicago, Illinois.
Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois.
JBJS Rev. 2023 Mar 16;11(3). doi: e22.00147. eCollection 2023 Mar 1.
»: Patients with diabetes are at higher risk for complications after surgical fixation of unstable fractures due to impaired neurovascular functioning and wound-healing capabilities.
»: Patients with uncontrolled diabetes have higher rates of complications when compared with patients with controlled diabetes.
»: Despite higher rates of complications, operative fixation of unstable ankle fractures in diabetic patients reliably leads to a functional lower extremity with an overall lower rate of complications than nonoperative management.
»: Operatively and nonoperatively managed ankle fractures in patients with diabetes should remain non-weight-bearing for an extended period of time.
»: Discussion of risk of poor outcomes including deep infection, loss of reduction, return to the operating room, and risk of arthrodesis or amputation should be explicitly discussed with patients and families when managing unstable ankle fractures in diabetic patients.
»: 由于神经血管功能和伤口愈合能力受损，糖尿病患者在不稳定骨折手术固定后发生并发症的风险更高。
»: 与糖尿病得到控制的患者相比，糖尿病控制不佳的患者并发症发生率更高。
»: 尽管并发症发生率较高，但糖尿病患者不稳定踝关节骨折的手术固定确实能使下肢功能良好，总体并发症发生率低于非手术治疗。
»: 糖尿病患者手术和非手术治疗的踝关节骨折均应长时间保持不负重。
»: 在处理糖尿病患者的不稳定踝关节骨折时，应与患者及其家属明确讨论包括深部感染、复位丢失、重返手术室以及关节融合或截肢风险等不良结局的风险。
