Primary Arthrodesis for Diabetic Ankle Fractures.

Autor:	Grote CW; Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA., Tucker W; Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA., Stumpff K; Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA., Birt MC; Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA., Horton GA; Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
Jazyk:	angličtina
Zdroj:	Foot & ankle orthopaedics [Foot Ankle Orthop] 2020 Mar 24; Vol. 5 (1), pp. 2473011420908841. Date of Electronic Publication: 2020 Mar 24 (Print Publication: 2020).
DOI:	10.1177/2473011420908841
Abstrakt:	Background: Treatment of ankle fractures in patients with diabetes is associated with increased complication rates. Ankle arthrodesis is considered a salvage procedure after failed ankle fracture fixation, yet primary ankle arthrodesis has been proposed as a treatment option for patients with significant diabetes-related complications. To date, the characteristics of patients who undergo primary ankle arthrodesis and the associated outcomes have not been described. Methods: A retrospective review was performed of 13 patients with diabetes who underwent primary arthrodesis for traumatic ankle fracture. Patient demographics were characterized in addition to their diabetes complications, Adelaide Fracture in the Diabetic Ankle (AFDA) score, and fracture type. Outcomes assessed included reoperation rates, infection rates, wound complications, nonunion/malunion, amputation, and development of Charcot arthropathy postoperatively. Results: Patients who underwent primary arthrodesis had high rates of diabetes complications, average AFDA scores of 6.4, and high rates of severe injuries, including 38.5% open fractures and 69.2% fracture dislocations. The overall complication rate for primary arthrodesis of ankle fractures in diabetes patients was more than 75% in this cohort. Complications included a 38.5% reoperation rate, 38.5% infection rate, 53.8% wound complication rate, and 23.1% amputation rate. Despite a high nonunion rate at the attempted fusion sites, 89.9% of fractures healed and patients had a stable extremity. Conclusion: This review is the first to characterize the epidemiology and complications of diabetes patients undergoing primary ankle arthrodesis for ankle fractures. In this cohort, patients with multiple diabetic complications and severe injuries underwent primary arthrodesis, which led to an overall high complication rate. Further research is needed to determine the appropriate treatment option for these high-risk patients, and tibiotalocalcaneal stabilization without arthrodesis may be beneficial. Level of Evidence: Level IV, retrospective case series. Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online. (© The Author(s) 2020.)
Databáze:	MEDLINE
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