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Treatment of ankle fractures in diabetic patients

Ebraheim, Nabil MD; Dammeyer, Kyle BS; Paull, Daniel MD

doi: 10.1097/BCO.0000000000000570

With an increasing population of diabetic patients and known complications of this disease, the treatment of ankle fractures in these patients has been of increasing interest over the past few decades. The purpose of this article was to review the literature and discuss the complications of ankle fractures in diabetic patients such as delayed wound healing, risk of infection, and amputation and to discuss the proper treatment methods to achieve a successful outcome. Diabetic patients with ankle fractures require twice the time as nondiabetic patients to achieve a successful union. Therefore, diabetic patients should be nonweight bearing for twice the recommended time for nondiabetic patients. However, there has been some success with protected weight bearing 2 wk after injury. Diabetic patients have an increased risk for infection at the surgical site and amputation so the skin should be carefully monitored for signs of infection. Patients should attempt to control their hemoglobin A1C to a level of <6.5% to increase the chance of a successful union, and displaced or unstable ankle fractures in the diabetic population should be treated surgically to avoid unnecessary complications. The use of bone marrow mesenchymal stem cells can aid in the treatment of ankle fracture nonunion in diabetic patients. Finally, diabetic patients with ankle fractures achieve better outcomes with additional fixation and a minimally invasive approach.

University of Toledo Department of Orthopedics

Financial Disclosure: The authors report no conflicts of interest.

Correspondence to Kyle Dammeyer, BS, C/o Nabil Ebraheim, Room 2448 Dowling Hall 1125 Hospital Drive Toledo, OH 43614 Tel: +419.383.6236; fax: +419.383.3526; e-mail:

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