title: Nonoperative Versus Operative Treatment of Displaced Ankle Fractures in Diabetics.
abstract: BACKGROUND
  Diabetes is a risk factor for complications related to displaced ankle fractures. Limited literature exists comparing complication rates in nonoperative versus operative treatment of displaced ankle fractures in diabetics. No study has highlighted the natural history of nonoperative treatment of displaced ankle fractures in diabetics.
  
  
  METHODS
  We retrospectively reviewed all adult ankle fractures from September 2011 through December 2014. Inclusion was limited to ambulatory adults (>18 years) with closed, displaced (widened mortise) ankle fractures with diabetes mellitus. Nonoperative treatment consisted of closed reduction and casting. Fractures were classified according to the Lauge-Hansen and AO-Weber classification systems. All operative fractures underwent open reduction internal fixation (ORIF) within 3 weeks of injury. Functional outcomes and complication rates were compared. Of 28 displaced diabetic ankle fractures, 20 were treated nonoperatively (closed reduction and casting) and 8 operatively (ORIF within 3 weeks of injury). Mean follow-up was 7 months (range 3-18 months).
  
  
  RESULTS
  Age, insulin-dependent diabetes, and AO type B fracture rate were similar in nonoperative and operative cohorts, but fracture dislocation rate was significantly higher among operative fractures (87.5% vs 40%; P = .04). Nonoperative treatment was associated with a 21-fold increased odds of complication compared with operative treatment (75% vs 12.5%, OR 21.0, P = .004). Complication rate following unintended ORIF for persistent nonunion or malunion in nonoperatively treated patients was significantly greater compared with immediate ORIF (100% vs 12.5%, P = .005).
  
  
  CONCLUSIONS
  Nonoperative treatment of displaced diabetic ankle fractures was associated with unacceptably high complication rates when compared to operative treatment.
  
  
  METHODS
  Level III, retrospective comparative series.
authors.affiliation: 1 Mount Sinai Hospital, Department of Orthopaedic Surgery, New York, NY, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lovy
authors.affiliation: 1 Mount Sinai Hospital, Department of Orthopaedic Surgery, New York, NY, USA.
authors.forename: James
authors.initials: J
authors.lastname: Dowdell
authors.affiliation: 2 Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Aakash
authors.initials: A
authors.lastname: Keswani
authors.affiliation: 1 Mount Sinai Hospital, Department of Orthopaedic Surgery, New York, NY, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Koehler
authors.affiliation: 1 Mount Sinai Hospital, Department of Orthopaedic Surgery, New York, NY, USA.
authors.forename: Jaehon
authors.initials: J
authors.lastname: Kim
authors.affiliation: 1 Mount Sinai Hospital, Department of Orthopaedic Surgery, New York, NY, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Weinfeld
authors.affiliation: 3 Elmhurst Hospital Center, Department of Orthopedic Surgery, Elmhurst, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Joseph
mesh_terms: D064386:Ankle Fractures / Q000209:etiology / Q000601:surgery*; D048909:Diabetes Complications / Q000150:complications* / Q000503:physiopathology; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Charcot; ankle; complications; diabetes; displaced; fracture; nonoperative; operative