الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
A
nkle fractures are of the most common injuries presented to orthopedic surgeons. Diabetes mellitus is a common disease with its incidence increasing annually with an ever-aging population. So the incidence of diabetic ankle fractures is increasing annually. Orthopedic surgeons should be aware of the special considerations recommended when managing these cases.
The prevalence of peripheral neuropathy in diabetic patients is high ranging from 19% to 50%. Peripheral neuropathy derives the ankle of its protective sensations making it more prone to injury. This may explain the fact that, the prevalence of diabetic peripheral neuropathy is higher in patients undergoing foot and ankle surgery than the general diabetic population 1.
Peripheral neuropathy also increases the rate of complications of ankle fractures compared to those of the non-complicated diabetics 2. These complications include infection, loss of fixation, charcot arthropathy and even up to amputation2. That’s why historically there was a trend to avoid operating upon a diabetic ankle fracture with peripheral neuropathy. However, non-operative management of unstable ankle fracture in this population resulted in a significant higher rate of complications than operative treatment, making the non-operative option questionable 3.
Here the surgeon faces another question; what method of fixation to choose. There are many factors to consider, including age, general condition, fracture pattern and the soft tissue condition3. There are many fixation options that include: standard fixation, the more rigid trans-syndesmotic tetracortical fixation, minimally invasive fixation4, percutaneous closed intramedullary nail, pin and bar external fixation and circular fixation and combined fixation 5.
Peripheral neuropathy also requires special postoperative management of those ankle fractures. It requires longer period of non-weight bearing and the protection with walking cast after weight bearing has begun6