PDF(Pubmed)
Abstract：
Objectives: Patients with ankle fractures associated with diabetes experience more complications following standard open reduction-internal fixation (ORIF) than those without diabetes. Augmented fixation strategies, namely extended ORIF and hindfoot nails (HFNs), may offer better results and early weightbearing in this group. The aim of this study was to define the population of patients with diabetes undergoing primary fixation for ankle fractures. Secondarily, we aimed to assess the utilisation of standard and augmented strategies and the effect of these choices on surgical outcomes, including early post-operative weightbearing and surgical complications. Methods: A national multicentre retrospective cohort study was conducted between January and June 2019 in 56 centres (10 major trauma centres and 46 trauma units) in the United Kingdom; 1360 patients with specifically defined complex ankle fractures were enrolled. The patients\' demographics, fixation choices and surgical and functional outcomes were recorded. Statistical analysis was performed to compare high-risk patients with and without diabetes. Results: There were 316 patients in the diabetes cohort with a mean age of 63.9 yrs (vs. 49.3 yrs. in the non-diabetes cohort), and a greater frailty score > 4 (24% vs. 14% (non-diabetes cohort) (p < 0.03)); 7.5% had documented neuropathy. In the diabetes cohort, 79.7% underwent standard ORIF, 7.1% extended ORIF and 10.2% an HFN, compared to 87.7%, 3.0% and 10.3% in the non-diabetes cohort. Surgical wound complications after standard-ORIF were higher in the diabetes cohort (15.1% vs. 8.7%) (p < 0.02), but patients with diabetes who underwent augmented techniques showed little difference in surgical outcomes/complications compared to non-diabetes patients, even though early-weightbearing rates were greater than for standard-ORIF. Conclusions: Ankle fractures in diabetes occur in older, frailer patients, whilst lower-than-expected neuropathy rates suggest a need for improved assessment. Augmented surgical techniques may allow earlier weightbearing without increasing complications, in keeping with modern guidelines in ankle fracture management.
摘要：
目标：与没有糖尿病的患者相比，在标准切开复位内固定（ORIF）后，与糖尿病相关的踝关节骨折患者的并发症更多。增强固定策略，即延长ORIF和后脚指甲（HFN），在该组中可能提供更好的结果和早期的负重。这项研究的目的是确定接受踝关节骨折初次固定的糖尿病患者的人群。其次，我们旨在评估标准和增强策略的使用情况以及这些选择对手术结果的影响，包括术后早期负重和手术并发症。方法：2019年1月至6月，在英国56个中心（10个主要创伤中心和46个创伤单位）进行了一项国家多中心回顾性队列研究；纳入了1360例明确定义的复杂踝关节骨折患者。病人的人口统计学，记录了固定选择以及手术和功能结局.进行统计分析以比较有和没有糖尿病的高危患者。结果：糖尿病队列中有316例患者，平均年龄为63.9岁（与49.3年。在非糖尿病队列中)，和更大的脆弱分数>4(24%与14%（非糖尿病队列）（p<0.03）；7.5%有神经病变记录。在糖尿病队列中，79.7%接受标准ORIF,7.1%扩展ORIF和10.2%的HFN，与87.7%相比，非糖尿病队列中的3.0%和10.3%。在糖尿病队列中，标准ORIF后的手术伤口并发症较高（15.1%vs.8.7%)(p<0.02)，但是，与非糖尿病患者相比，接受增强技术的糖尿病患者在手术结果/并发症方面几乎没有差异，即使早期负重率高于标准ORIF。结论:糖尿病患者踝关节骨折多发生于老年人,脆弱的病人，而神经病变率低于预期提示需要改进评估.增强手术技术可以在不增加并发症的情况下实现早期负重，符合踝关节骨折治疗的现代指南。
