title: Early Protected Weightbearing After Ankle Fractures in Patients With Diabetes Mellitus.
abstract: The traditional protocol for treatment after ankle fracture in the diabetic patient involves a period of prolonged non-weightbearing to reduce the incidence of complications. The goal of the present study was to identify the risk factors and complications associated with early protected weightbearing after closed ankle fractures in patients with diabetes. The data from 73 diabetic patients with operatively and nonoperatively treated ankle fractures were retrospectively reviewed. All patients were allowed to begin protected weightbearing in a cast or removable boot at 2 weeks after the index injury or surgery. The mean follow-up period was 51 (range of 26 to 480) weeks. Complications occurred in 25% of the operative cases and 8% of the nonoperative cases. In both categories, the complication rate was less than that from existing reports using prolonged non-weightbearing. Wound dehiscence was the most common complication in the operatively treated patients (18.8%). A statistically significant difference was found in the complications rates for the patients aged >60 years (p = .0403). No statistically significant differences were identified according to hemoglobin A1c, the presence of peripheral neuropathy, smoking status, fracture type, or the presence of end-stage renal disease. The results of the present study suggest that early protected weightbearing after closed ankle fractures in diabetic patients is fairly safe, with an acceptable complication rate. However, the patients selected for early weightbearing had low comorbidity profiles, which might have accounted, in part, for the low complication rate.
authors.affiliation: Attending Staff, Division of Podiatry, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA.
authors.forename: Irina
authors.initials: I
authors.lastname: Bazarov
authors.affiliation: Attending Staff, Department of Orthopedics and Podiatry, Kaiser Permanente Medical Center, Vacaville, CA.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Peace
authors.affiliation: Surgeon, Financial District Foot and Ankle Center, San Francisco, CA.
authors.forename: Pieter M
authors.initials: PM
authors.lastname: Lagaay
authors.affiliation: Chief of Podiatry, Department of Orthopedics and Podiatry, Kaiser Permanente Antioch, Antioch, CA.
authors.forename: Sandeep B
authors.initials: SB
authors.lastname: Patel
authors.affiliation: Data Consultant, Division of Research, Kaiser Permanente, Oakland, CA.
authors.forename: Liisa L
authors.initials: LL
authors.lastname: Lyon
authors.affiliation: Chief, Foot and Ankle Surgery, Department of Orthopedic Surgery, Kaiser Foundation Hospital, San Francisco, CA. Electronic address: Jmfoot@yahoo.com.
authors.forename: John M
authors.initials: JM
authors.lastname: Schuberth
mesh_terms: D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D002370:Casts, Surgical; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D004434:Early Ambulation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016474:Weight-Bearing / Q000502:physiology*
keywords: ankle fracture; diabetes mellitus; early weightbearing