Natural History of Diabetic Foot and Ankle Fractures: A Retrospective Review of 40 Patients

Background: Ankle fractures in diabetics with secondary complications are more prone to postoperative complications than ankle fractures in diabetics without secondary complications. This study retrospectively compared the post injury complications of foot and ankle fractures in diabetics with and without secondary complications. Secondary complications of diabetes mellitus include peripheral arterial disease, nephropathy, and/or peripheral neuropathy. Uncomplicated diabetics did not have any of these end organ diseases associated with diabetes. Our hypothesis was that foot and ankle fractures in complicated diabetics would incur more post injury complications than uncomplicated diabetics. Materials and Methods: We contrasted the post injury complications of foot and ankle fractures in 25 complicated diabetics with15 uncomplicated diabetics. Results: At an average follow-up of 33.8 weeks we established that foot fractures in complicated diabetics had a non significant trend of a 2.8 times increase in overall post injury complications versus foot fractures in uncomplicated diabetics. Furthermore, with an average follow up of 28.8 weeks we demonstrated a non significant tendency of a 1.4 times increase in overall post injury complications of ankle fractures in complicated diabetics compared to ankle fractures in uncomplicated diabetics. Lastly, with a mean follow up of 33.7 weeks we found insignificant trends of a 1.7 times increase in overall post injury complications and a 2.8 times increase in noninfectious complications (malunion, delayed union, nonunion or Charcot neuroarthropathy) in complicated diabetic foot and ankle fractures contrasted to uncomplicated diabetic foot and ankle fractures. Conclusion: Foot and ankle fractures in complicated diabetics are presumably at an increased risk of developing a post injury complication compared to uncomplicated diabetics. Specifically, foot fractures should be treated similar to ankle fractures in complicated diabetics with an extended period of non-weight-bearing in a total contact cast. Mandatory post injury clinical evaluation for peripheral arterial disease, peripheral neuropathy and nephropathy should be implemented. This analysis will be used as a template for a future prospective comparative study evaluating foot and ankle fractures in complicated and uncomplicated diabetics with a power analysis to achieve statistical significance.