Acute complications in the operative treatment of isolated ankle fracturesin patients with diabetes mellitus

Using a computer database, we conducted a retrospective review of all ankle fractures treated at our institution from March 1985 to October 1996. Twen ty-one patients with diabetes mellitus and isolated ankle fractures that we re treated operatively met all inclusion criteria. Seven had insulin-depend ent diabetes, and 14 had non-insulin-dependent diabetes. A randomly selecte d control group of 46 patients without diabetes who also underwent operativ e treatment of ankle fractures during this same time period were matched fo r age, sex, and fracture severity. The complication rate was 43% with 13 co mplications in nine patients with diabetes. There were seven (15.5%) compli cations in the control group, Complications in the diabetic group included seven infections (five deep, two superficial) and three losses of fixation. The complications were more severe in our diabetic population, requiring s even additional procedures including two below-knee amputations; a third pa tient refused an amputation. No additional procedures were required in our control group. All complications in our control group resolved with treatme nt. The relative risk for postoperative complications in patients with diab etes who sustained ankle fractures that were treated operatively was 2.76 t imes greater than the control group's (95% confidence interval, 1.57-3.97).