الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Ankle fractures are of the most injuries presented to orthopedic
surgeon. Diabetes mellitus is a common disease with its incidence
increasing annually with ever-aging population. Orthopedic surgeon
should beware of the special consideration recommended when managing
these cases.
The prevalence of peripheral neuropathy 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 ankle foot and ankle surgery than the general population.
Peripheral neuropathy also increases the rates of complications of
ankle fractures compared to the non-complicated diabetic,2
these
complications includes infection, loss of fixation, charcot‟s neuropathy
and even up to amputation. 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
fractures in this population resulted in a significant higher rate of
complications than operative treatment, making the non-operative
treatment questionable.
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 condition. There are many
fixation options that include: standard fixation the more rigid transsyndesmotic tetra-cortical fixation, minimally invasive fixation,
A
Summary
94
percutaneous closed intramedullary nail, pin and bar external fixation and
circular fixation and combined fixation .
Peripheral neuropathy also requires special post-operative
management of those ankle fractures. It requires longer period of nonweight-bearing and the protection with walking cast after weight-bearing
has begun.
Diabetes also appears to dramatically increase the risk of lower
extremity amputation because of infected, non-healing foot ulcers. The
rates of amputation in diabetic populations are typically10 to 20 times
those of non-diabetic individuals and over the past decade have ranged
from 1.5to 3.5 events per 1000 persons per year in populations with
diagnosed diabetes.
The main aim of this study was to evaluate the radiological and
clinical outcome of operative treatment of ankle fractures in diabetic
patients.
This prospective study was conducted on 21 diabetic patients with
ankle fractures managed operatively, at least half of these cases were
operated on the orthopedic department of Menoufia University hospital
and the rest of the cases were operated on ELSheikh Zayed ALnahyan
Hospital.
Summary
95
The main results of the study revealed that:
The mean age was 51.5 ± 9.2 years old (range, 35 – 66 years old).
Patients were classified into three age groups: less than 40 (n = 3),
between 40 and 60 (n = 13), and more than 60 years old (n = 5).
The mean BMI was 35.6 ± 3.4 Kg/m2
(range, 30 – 42). All
included patients were obese. Eight (38%) patients were mildly
obese (class I), 10 (48%) patients were moderately (obese) class II,
and three (14%) patients were morbidly obese (class III).
The mean duration of DM was 9.1 ± 3.6 years (range, 3 – 15
years). Eight (38%) patients were found to be insulin dependent.
The mean values for laboratory measurements were within normal
ranges. The mean value of HbA1c was 7.8% ± 0.8% (range, 7% –
9%). The mean blood glucose level was 159.3 ± 23.3 mg/dl (range,
120 – 197 mg/dl). The mean level of serum creatinine was 1.29 ±
0.4 mg/dl (range, 1 – 2 mg/dl).
Nine (43%) of the fractures were low-energy trauma resulting from
twisting injuries; three had slipped on the ground, four had
stumbled in a staircase, and two were minor bicycle accidents.
Eight fractures were caused by RTA, and four had occurred when
falling from height and were thereby classified as high-energy
trauma. In twelve (57%) cases, the left ankle was injured.
A statistically significant improvement in ankle scores was found
between the two follow-ups (Paired sample t test, P = .000).
Summary
96
Some sort of pain was reported from 11 (52%) subjects at 6 months
and from eight (38%) after 12 months, especially while walking on
uneven surface. Four (19%) patients experienced stiffness that did
not improve at 12-month follow-up. Seven (33%) patients
complained of ankle swelling at 6 months, where only two had
their ankle swelling resolved at 12 months. Thirteen (62%) and 10
(48%) patients had reduced activities of daily living compared to
pre-injury after 6 and 12 months, respectively.
When comparing complication rates between complicated DM and
non-complicated DM, patients with associated diabetic
comorbidities were found to have a significantly higher incidence
of postoperative adverse events.
Based on our results we recommend for further studies on larger
patients and longer period of follow up to emphasize our conclusion