Diabetic Ankle Fracture 824.4

 
ICD-9 Classification / Treatment
Etiology / Epidemiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

Diabetic Ankle Fracture ICD-9

 

Diabetic Ankle Fracture Etiology / Epidemiology / Natural History

  •  Higher complication rates; significantly higher in-hospital mortality rate, in-hospital postoperative complication rate, length of stay, and rate of nonroutine discharges. Complications include impaired wound healing, infection, malunion, loss of reduction, hardware failure, nonunion, and Charcot arthropathy (Jones KB, JBJS 2005;87Br:489), (Chaudahary SB, JAAIS 2008;16:159).
  • Pathology = microangiopathy, hyperglycemia, hypoxia and peripheral neuropathy leading to impaired soft-tissue and fracture healing.

Diabetic Ankle Fracture Anatomy

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Diabetic Ankle Fracture Clinical Evaluation

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Diabetic Ankle Fracture Xray / Diagnositc Tests

  •  Transcutaneous oxygen pressure (tcPO2) > 30 mm of mercury (Hg) is generally required for the healing of diabetic surgical wounds.
    Doppler toe pressure measurements associated with adequate limb perfusion is 30 mm Hg.
    Semmes-Weinstein monofilament (SWM). The ability to feel a 4.17 Semmes-Weinstein monofilament implies normal protective sensation The inability to sense the 5.07 SWM (10 g) monofilament correlates with the presence or history of an ulcer and neuropathy.

Diabetic Ankle Fracture Classification / Treatment

  •  Treatment: prompt reduction and splinting to reduce soft-tissue trauma, followed by delayed surgery after resolution of edema and medical maximization. Consider external fixation to maintain reduction while the soft-tissues stabilize. External fixation may be definitive treatment if severe soft-tissue injury is present. Skin wrinkles at the surgical site indicates definitive fixation is appropriate. Supplementation to standard ankle fixation is commonly required.
  • The most important factor in maintaining a proper milieu for wound healing in the patient with diabetes is physiologic blood glucose control

Diabetic Ankle Fracture Associated Injuries / Differential Diagnosis

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Diabetic Ankle Fracture Complications

Diabetic Ankle Fracture Follow-up Care

  •  Diabetic patients have a 187% increase in time to union. (Loder RT, CORR 1988;232:210).

Diabetic Ankle Fracture Review References


 

 

 

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