The management of ankle and hindfoot fractures in people with diabetes

A new article examines the special attention required in the management of ankle fractures among people with diabetes, to reduce the risk of complications and injury.

Consultant Orthopaedic Surgeon Ngwe Phyo and Trauma and Orthopaedic Consultant Alexander Wee, from the Department of Trauma and Orthopaedics at Frimley Park Hospital, have outlined some of the key principles in the treatment of one of the most common injuries to be presented at emergency departments.

Their key points are:

  • Diabetic patients with ankle fracture risk a higher incidence of complication after injury and treatment
  • Understanding of pathophysiology relating to undesired outcomes is crucial
  • Caution is required when nonoperative management is considered for ankle fracture in patients with peripheral neuropathy
  • Limb salvage should be the key objective.

While ankle fractures are frequently seen in A&E, hindfoot fractures such as talus and calcaneal fractures are less common. According to recent figures, the incidence of diabetes in patients with ankle fractures ranges from 1 in 20 to 1 in 7.

The authors say that: “Vigilance is required when opting for nonoperative treatment in undisplaced stable ankle fractures in patients with peripheral neuropathy. The presence of critical ischemia in injured limb demands vascular consultation and ultimately, an intervention before surgical fixation of ankle fracture.

“An extended period of immobilisation is one of the key principles in the management of ankle fracture patients with diabetes.”

The article has been published in the journal Foot and Ankle Clinics as part of a special issue, The Diabetic Foot.

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