title: Fluoroscopy-guided reduction and fibular nail fixation to manage unstable ankle fractures in patients with diabetes: a retrospective cohort study.
abstract: OBJECTIVE
  Patients with diabetes are at increased risk of wound complications after open reduction and internal fixation of unstable ankle fractures. A fibular nail avoids large surgical incisions and allows anatomical reduction of the mortise.
  
  
  METHODS
  We retrospectively reviewed the results of fluoroscopy-guided reduction and percutaneous fibular nail fixation for unstable Weber type B or C fractures in 24 adult patients with type 1 or type 2 diabetes. The re-operation rate for wound dehiscence or other indications such as amputation, mortality and functional outcomes was determined.
  
  
  RESULTS
  Two patients developed lateral side wound infection, one of whom underwent wound debridement. Three other patients required re-operation for removal of symptomatic hardware. No patient required a below-knee amputation. Six patients died during the study period for unrelated reasons. At a median follow-up of 12 months (7 to 38) the mean Short Form-36 Mental Component Score and Physical Component Score were 53.2 (95% confidence intervals (CI) 48.1 to 58.4) and 39.3 (95% CI 32.1 to 46.4), respectively. The mean Visual Analogue Score for pain was 3.1 (95% 1.4 to 4.9). The mean Ankle Osteoarthritis Scale total score was 32.9 (95% CI 16.0 to 49.7).
  
  
  CONCLUSIONS
  Fluoroscopy-guided reduction and fibular nail fixation of unstable ankle fractures in patients with diabetes was associated with a low incidence of wound and overall complications, while providing effective surgical fixation. Cite this article: Bone Joint J 2016;98-B:1197-1201.
authors: University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors: B D
authors: BD
authors: Ashman
authors: University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors: C
authors: C
authors: Kong
authors: University of British Columbia, St. Paul's Hospital, 530 - 1144 Burrard Street, Vancouver, BC, V6Z 2A5, Canada.
authors: K J
authors: KJ
authors: Wing
authors: University of British Columbia, St. Paul's Hospital, 530 - 1144 Burrard Street, Vancouver, BC, V6Z 2A5, Canada.
authors: M J
authors: MJ
authors: Penner
authors: The Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, Scotland, EH16 4SA, UK.
authors: K E
authors: KE
authors: Bugler
authors: The Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, Scotland, EH16 4SA, UK.
authors: T O
authors: TO
authors: White
authors: University of British Columbia, St. Paul's Hospital, 530 - 1144 Burrard Street, Vancouver, BC, V6Z 2A5, Canada.
authors: A S E
authors: AS
authors: Younger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001858:Bone Nails; D015331:Cohort Studies; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005360:Fibula / Q000293:injuries / Q000601:surgery; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Ankle fracture; Diabetes; Fibular nail; Reoperation; Weber B fibular fracture; Weber C fibular fracture; Wound infection