Outcome In Ankle Fractures In Diabetic Vs Non- Diabetics

摘要

Background: Ankle fractures in diabetic patients have always been considered difficult injuries and previous studies in this field showed that the incidence of complication can be in the range of 32%3 to 42.3%6.Aims: The aim of this study was to assess the outcome in ankle fractures in diabetic population and to find out reasons for any results contrary to previous studies. Methods: We performed a case control study comparing a group of 24 diabetic patients, with ankle fractures, with a group of 48 non-diabetic patients demographically similar for age, gender, type of injury, treatment provide and length of follow-up. In diabetic group 9 were treated conservatively and 15 had ORIF while in non-diabetic group 16 were treated conservatively and 32 underwent operative treatment. The diabetic and non-diabetic groups were followed up for mean periods of 50.3 months and 43.1 months respectively and on the conclusion of the study a clinic was arranged in April 2003 and the outcome was assessed according to the 100 point Maryland foot score.Results: In the diabetic group 4 patients while in the non-diabetic group 7 patients developed complications. None of the 72 patients in this study required further surgery. The mean Maryland foot score of diabetic group was 95.08 and that of non- diabetic group was 93.79.Conclusion: Our study shows that in the presence of optimal control of diabetes mellitus and careful patient selection for type of treatment, these lesions can result in an outcome comparable to non-diabetic patients with similar injuries (p = 0.086). Introduction Diabetes Mellitus (DM) has always been recognised as a significant co-morbidity when treating an ankle fracture. The treatment is difficult and challenging in terms of both wound healing and fracture healing. There is significant controversy in regard to the best treatment option i.e. whether to treat these injuries conservatively by closed reduction and immobilisation cast or by open reduction and internal fixation (ORIF).We performed a case-controlled study to compare the outcome in diabetic patients with ankle fracture with a matched group of non-diabetic patients. Previous studies in this controversial area showed that the incidence of complication can be in the range of 32%3 to 42.3%6 and can even result into amputations7.In 2000 Flynn et al published their experience of 25 diabetic patients treated for ankle fractures. They found that the risk of infection in diabetic group was 4 times higher than non-diabetic control group (32% vs. 8%). This series included only closed fractures. In 1998 McCormack and Leith compared the results of management of displaced malleolar fractures in 26 diabetic patients with those of a matching group of 26 non-diabetic patients. In this series 11 out of 26 diabetic patients developed complications compared with none in non-diabetic group. In 1995 Low and Tan observed that the incidence of infection is increased in diabetic population. This series included only 10 diabetic patients, which is statistically insignificant to draw any conclusions.In our unit we observed a very low complication rate in diabetic patients. We looked at results retrospectively to find the reason for lower complication rate in diabetic patients treated for ankle injuries including closed and open fractures. The aim of our study is to show that in the presence of optimal diabetic control by long-term multi-disciplinary input and judicious use of antibiotics the outcome in diabetic population ankle fractures could be comparable to control group. Patients And Methods Between January 1995 and February 2002, all diabetic patients treated in our institute with ankle factures were identified from the database. Those who died due to causes not related to ankle injury or as a result of surgical complication or were not contactable due to any other reason were excluded from the study. The selected group included 24 diabetic patients with 44-B and C lesions according to AO