Fx de tobillo en pacientes con dm

This is an enhanced PDF from The Journal of Bone and Joint Surgery The PDF of the article you requested follows this cover page.

The Management of Ankle Fractures in Patients with Diabetes
Dane K. Wukich and Alex J. Kline J Bone Joint Surg Am. 2008;90:1570-1578. doi:10.2106/JBJS.G.01673

This information is current as of May 15, 2010 FREE Spanish Translation Reprints and Permissionshttp://www.ejbjs.org/cgi/content/full/90/7/1570/DC1 Click here to order reprints or request permission to use material from this article, or locate the article citation on jbjs.org and click on the [Reprints and Permissions] link. The Journal of Bone and Joint Surgery 20 Pickering Street, Needham, MA 02492-3157 www.jbjs.org

Publisher Information

1570
C OPYRIGHT Ó 2008
BY

T HE J OURNAL

OFB ONE

AND J OINT

S URGERY, I NCORPORATED

Current Concepts Review

The Management of Ankle Fractures in Patients with Diabetes
By Dane K. Wukich, MD, and Alex J. Kline, MD
ä

Patients with diabetes mellitus have higher complication rates following both open and closed management of ankle fractures. Diabetic patients with neuropathy or vasculopathy have higher complication ratesthan both diabetic patients without these comorbidities and nondiabetic patients. Unstable ankle fractures in diabetic patients without neuropathy or vasculopathy are best treated with open reduction and internal fixation with use of standard techniques. Patients with neuropathy or vasculopathy are at increased risk for both soft-tissue and osseous complications, including delayed union and nonunion.Careful soft-tissue management as well as stable, rigid internal fixation are crucial to obtaining a good outcome. Prolonged non-weight-bearing and subsequently protected weight-bearing are recommended following both operative and nonoperative management of ankle fractures in patients with diabetes.

ä

ä

ä

ä

Ankle fractures are among the most common injuries treated by orthopaedicsurgeons, with an estimated 260,000 occurring per year in the United States1,2. With an ever-aging population, the number of ankle fractures continues to rise3. While protocols for management of ankle fractures are generally well established, treatment of these injuries in patients with diabetes mellitus poses a challenge for orthopaedists. These patients have unique characteristics, includingdelayed fracture-healing, impaired wound-healing, vasculopathy, and neuropathy, that all must be taken into account when formulating a treatment plan. As the prevalence of diabetes mellitus has continued to increase, so too has the number of ankle fractures seen in this patient population. While much has been published on the impact of diabetes on the treatment of ankle fractures, the majority ofstudies have included a small number of patients and have been either retrospective reviews or case-control studies. In this review, we will report the impact of diabetes on the management of ankle fractures. Specifically, we will examine the epidemiology of diabetes as it relates to ankle fractures, the specific characteristics of

diabetes that pose a problem in the management of ankle fractures(impaired wound-healing, delayed fracture-healing, and neuropathy), the information in the literature as it relates to outcomes and complications following the management of these fractures in diabetics, and current evidence regarding the optimal management of ankle fractures in patients with diabetes. A critical analysis of the existing evidence regarding the impact of diabetes on ankle fractures willlead to a better understanding of this problem and the ability to make better decisions for patient management. Epidemiology of Diabetes According to statistics from the Centers for Disease Control and Prevention in 2005, 20.8 million people (7% of the population) in the United States had diabetes mellitus4. In the population over the age of sixty years, 10.3 million (20.2% of the population)...