How To Treat Ankle Fractures In Patients With Diabetes?

• April 6, 2019
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If not precisely treated ankle fractures in patients with diabetes could lead to very serious or even dire consequences. Below we discuss ways to reduce these risks and how to improve patient outcomes. Diabetic patients with a fractured ankle can present clinicians with problems in both operative as well as operative care. Complications which may arise, such as vasculopathy and neuropathy can be compounded by other recovery issues which happen more frequently in those with diabetes.  For diabetic patients with a fractured ankle this guide has full information on ankle fractures and how to recover visit this link The Health Experts to help increased chance of successful and shorter recovery time.

 

For many patients, these chronic problems will not present until they have a fractured ankle or broken ankle. Diabetic ankle fractures can lead to complications such as:

 

• Higher infection risks.
• Delayed union, nonunion, malunion.
• Charcot arthropathy.

 

Additionally, wounds which do not heal as well. Such complications can compound a routine injury such as a broken ankle and lead to ankle fracture complications from diabetes, resulting in loss of a limb in extreme cases. In cases where there the patient has diabetes and broken bones in their foot or ankle, it is critical staff are aware of how to treat the patient

 

Some relevant statistics from the US CDC show that in the USA,

 

• 25.8 million people has type 1 diabetes.
• A greater percentage of these are over 65.
• Between 1988 and 2000, of 160,000 people treated for a fractured ankle, 5.71% also had type 2 diabetes.

Findings From Studies Of Diabetic Patients With Ankle Fractures

There are many studies which look at diabetes and healing broken bones, such as ankle fracture complications with diabetes. These have shown that patients both diabetes and a broken ankle have higher chances of complications such as those listed above. One such study showed that risks were 2.74 times higher in patients with a broken ankle and diabetes than those presenting without diabetes.

 

31% of diabetic patients with ankle fractures suffered complications, in comparison to 17% of non-diabetic patients. Another study also looked at the results of fourteen diabetic open ankle fractures. Eight of these developed complications and five lead to amputations. Of the fourteen, just three did not suffer any complications.

Information For Treating Ankle Fractures In Diabetic Patients

An important part of treatment of ankle fractures in patients with diabetes is monitoring and tight glycemic control. It has been shown maintaining control of levels of glucose can help broken ankle wounds to heal. This has also been shown in studies of rat models. A comparative study of rats with and without insulin treatments show improved healing in the treated group. A reduction of hemoglobin A1c levels by 1% lead to a fall in the rate of complications of 25% – 30%. This underscores how important it is to properly control glucose levels to reduce the chance of complications of ankle fracture in patients with diabetes. If you are unsure if you have broken your ankle visit this NHS page on how do i know i have broken a bone?.

 

It is also necessary to address ischemia which can impede the healing of wounds and fractures. Peripheral arterial disease can be detected by using the ankle-brachial index. Other evaluation methods include measuring transcutaneous oxygen tension. These values help to predict rates of healing in diabetic ankle fractures. Lower values indicate the need for an xray of the blood vessels. Abnormal findings need to be evaluated by vascular specialist.

 

There are different ideas for how to treat patients with diabetic ankle fractures and there are few studies which specifically look at this. One study showed that surgical treatment resulted in complications for around 47% of patients. This contrasted to no complications in those treated in a more conservative way. Thus it was recommended that surgery is avoided where possible. Another study reviews the outcome of 28 (neuropathic) diabetic ankle fractures who all had more conservative treatment. This included immobilisation and rest. All patients healed with no complications.

 

Conversely, another study showed that patients with insulin-dependent diabetes and ankle fractures who were treated non-surgically all suffered one or more complications. One of the six patients even required an amputation. This study recommended early surgical treatment. Displaced fractures do require surgical intervention. But, surgical staff must take steps to reduce the risk of ankle fracture surgery in diabetic patients.

 

Treatment protocols should be adhered to in order to reduce the risk of complications of ankle fracture in patients with diabetes.

 

1. The broken ankle and the surrounding soft tissue should be assessed to help determine the right treatment.
2. If required, you should perform a closed reduction of the ankle fracture if there is gross disfigurement. This helps to avoid ischemic complications and problems with the wound.
3. The stability of the fracture or break should also be assessed. A splint or other methods can be used to encourage stability in the joint.
4. If necessary, external fixators could be used to facilitate surgical interventions in fractures which are unstable.

 

Various authors of studies have shown that lower rates of complications with regards to diabetes and healing broken bones with staged protocols in a patient with what is called a ‘high energy’ pilon fracture. These patients are comparable to diabetic patients. Both groups have a higher risk of complications and require soft tissues to be stabalised prior to open treatments.

 

As a patient who has diabetes is at a higher risk of suffering complications, it can be harder to avoid these complications. Treatment strategies for broken or fractured ankles could include;

 

• Using external fixators to stabalise the injury and accommodate soft tissue injuries.
• Use multiple debridements.
• Use of antibiotics and antibiotic implants.
• Closing the wound with skin grafts or flaps.
• Definitive treatment through arthrodesis.

Drawing Conclusions

What conclusions can we draw about the complications of ankle fracture in patients with diabetes? There are higher risks for this category of patient and conditions such as vasculopathy, neuropathy and delayed healing can transform a routine injury into one which threatens the limb as a whole. Correct management of diabetic symptoms, such as glucose levels is crucial to avoid said complications. Whilst there are many surgical and non-surgical options for treatment, management of the soft tissues and maintaining stability in the injury are essential. If complications do arise, a strategy using surgery and other treatments will be needed to prevent you losing a limb.