Infection rates in Singaporeans with and without complicated diabetes after ankle fracture surgery.
OBJECTIVE
To compare infection rates in Singaporeans with and without complicated diabetes after ankle fracture surgery.


METHODS
Medical records of 18 men and 27 women aged 38 to 84 (mean, 62) years with complicated (n=12) or uncomplicated (n=33) diabetes who underwent internal fixation for closed ankle fractures were reviewed. Complicated diabetes was defined as having end organ dysfunction. The control of diabetes was categorised as good (n=19), fair (n=10), and poor (n=16), based on HbA1c level within 4 months before or after surgery. Patients were followed up at weeks 2, 6, 12, and 24, with bone union as the end point.


RESULTS
The mean follow-up period was 9 (range, 4-12) months. 2 (6%) of 33 patients with uncomplicated diabetes and 6 (50%) of 12 patients with complicated diabetes developed superficial or deep infection. No patient died or underwent amputation secondary to infection. In multivariable logistic regression analysis after adjusting for co-morbidities, only complicated diabetes was a risk factor for postoperative infection (odds ratio=11.85, p=0.01). The odds of postoperative infection was 11.85 times higher in patients with complicated diabetes than with uncomplicated diabetes.


CONCLUSIONS
In patients with complicated diabetes, careful patient selection, peri-operative precaution, and closer monitoring are recommended if surgery is necessary.
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
Tong Leng
TL
Tan
Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore.
Jacob Y L
JY
Oh
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
Ernest Beng Kee
EB
Kwek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000150:complications / Q000601:surgery*; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology
ankle fractures; diabetes mellitus; surgical wound infection