Closed ankle fractures in the diabetic patient

Systemic and local manifestations of diabetes mellitus may complicate the t reatment of ankle fractures in the diabetic population. We studied 98 patie nts (73 non-diabetics and 25 diabetics) who were treated for closed ankle f ractures by either surgical or non-surgical methods. We found that overall, the risk of infection in the diabetic population (32%) was 4 times higher than in the non-diabetic population (8%), The infection rate in the diabeti c group treated surgically more than doubled that in the non-diabetic group . Four out of six diabetic patients treated with cast became infected compa red to no infections in the five non-diabetics treated with a cast, Even th ough the diabetic foot and ankle are well studied, the medical literature i s not conclusive regarding the management of ankle fractures in the diabeti c patient. Diabetic patients treated conservatively had a tendency to becom e infected over those treated surgically, Peripherovascular disease, periph eral neuropathy and swelling and/or echymosis increased the risk of infecti on in the diabetic population. Diabetic patients with poor compliance had a tendency to become infected more than those who were compliant. We concluded that the diabetic patient who is poorly compliant with evidenc e of neuropathic disease, peripherovascular disease and severe swelling and echymosis presents the most difficult group to manage. Although these pati ents are poor surgical candidates, they are also the most difficult to mana ge and also most prone to infection and complications if treated conservati vely. When faced with this difficult scenario a multidisciplinary team appr oach would probably yield the best possible results by early identification and intervention in these patients.