title: Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes.
abstract: BACKGROUND
  Patients with diabetes who sustain an ankle fracture are at increased risk for complications including higher rates of in hospital mortality, in-hospital postoperative complications, length of stay and non-routine discharges. The purpose of this study was to retrospectively compare the complications associated with operatively treated ankle fractures in a group of patients with uncomplicated diabetes versus a group of patients with complicated diabetes. Complicated diabetes was defined as diabetes associated with end organ damage such as peripheral neuropathy, nephropathy and/or PAD. Uncomplicated diabetes was defined as diabetes without any of these associated conditions. Our hypothesis was that patients with uncomplicated diabetes would experience fewer complications than those patients with complicated diabetes.
  
  
  METHODS
  We compared the complication rates of ankle fracture repair in 46 patients with complicated diabetes and 59 patients with uncomplicated diabetes and calculated odds ratios (OR) for significant findings.
  
  
  RESULTS
  At a mean followup of 21.4 months we found that patients with complicated diabetes had 3.8 times increased risk of overall complications 3.4 times increased risk of a non-infectious complication (malunion, nonunion or Charcot arthropathy) and 5 times higher likelihood of needing revision surgery/arthrodesis when compared to patients with uncomplicated diabetes. Open ankle fractures in this diabetic population were associated with a three times higher rate of complications and 3.7 times higher rate of infection.
  
  
  CONCLUSIONS
  Patients with complicated diabetes have an increased risk of complications after ankle fracture surgery compared to patients with uncomplicated diabetes. Careful preoperative evaluation of the neurovascular status is mandatory, since many patients with diabetes do not recognize that they have neuropathy and/or peripheral artery disease.
authors.affiliation: UPMC Comprehensive Foot and Ankle Center, Orthopaedic, 2100 Jane St., Pittsburgh, PA 15203, USA. wukichdk@upmc.edu
authors.forename: Dane K
authors.initials: DK
authors.lastname: Wukich
authors.forename: Alison
authors.initials: A
authors.lastname: Joseph
authors.forename: Michael
authors.initials: M
authors.lastname: Ryan
authors.forename: Claudia
authors.initials: C
authors.lastname: Ramirez
authors.forename: James J
authors.initials: JJ
authors.lastname: Irrgang
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data; D016512:Ankle Injuries / Q000628:therapy*; D001174:Arthrodesis / Q000706:statistics & numerical data; D001177:Arthropathy, Neurogenic / Q000209:etiology; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D005596:Fractures, Closed / Q000628:therapy*; D017759:Fractures, Malunited / Q000209:etiology; D005597:Fractures, Open / Q000628:therapy*; D005599:Fractures, Ununited / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology