Abstract
Aim To assess the outcome of ankle fractures in diabetic patients.
Method The case notes and X-rays of 39 patients with diabetes, who had sustained ankle fractures between 1994–2003, were retrospectively analysed.
Results There were 23 females and 16 males with mean age of 66 years in females and 51 years in males. The fracture was the result of a twisting injury in 37 of 39 patients. The average duration of diabetes prior to the fracture was 9.6 years. Thirty per cent of patients had systemic complications. Twenty patients had insulin dependent and 19 had non-insulin dependent diabetes. Fractures were on the left side in 21 patients. One patient had a Gustilo grade 2 fracture. Two had a single malleolar fracture, 28 had bi-malleolar fractures and the remaining nine had tri-malleolar fractures. Talus shift was present in 26 cases. The average time to surgery is 3.8 days. The mean ASA grade is 2.3. Twenty-one patients were managed operatively, of which seven had an infection. One patient underwent amputation. One had post-operative myocardial infarction. Nineteen were managed conservatively and in this group, four patients had infected pressure sores from the plaster, of which two needed plastic surgery care. One was managed with external fixator and developed osteomyelitis, and persistent talus shift and non-union.
Three patients died within 2 years of fracture due to diabetes-related complications. Union was achieved in 36 cases and 30 of the patients walked independently after union.
Conclusion There is a high complication rate following surgery for fractures of the ankle in diabetic patients, but conservative treatment also carries a significant risk because poor skin condition can lead to pressure sores while in plaster and these may need major plastic interventions.
Correspondence should be addressed to BOFSS, c/o Wrightington Wigan and Leigh NHS Trust, Hall Lane, Appley Bridge, Wigan, Lancashire WN7 9EP.
