■在糖尿病患者中,周围神经病患者踝关节骨折后出现并发症的风险增加.虽然这些患者非手术治疗的结果很差,接受切开复位和内固定术的患者的结局最好是适度的.我们假设,在这种容易发生并发症的患者组中,闭合复位和胫骨骨钉内固定是有效的主要手术。
■对患有周围神经病变的糖尿病患者进行回顾性分析,这些患者在两个1级创伤中心接受了踝关节骨折的闭合复位和内固定治疗。确定了30例患者,并根据其术后负重方案分为2组:早期负重(EWB)组20例,触地负重(TDWB)组10例。主要结局是基线功能的恢复率,次要结局包括伤口裂开的发生率,伤口感染,植入失败,失去固定,减少和截肢的损失。
■在EWB组中,15/20患者恢复到基线功能,5/20有伤口裂开和感染,2/20植入失败,5/20失去了固定,4/20减少了损失,和4/20接受截肢。在TDWB组中,9/10患者恢复到基线功能,1/10植入失败,1/10失去固定。该组中没有患者减少或接受截肢。
■在这种容易发生并发症的患者组中,使用胫骨骨钉治疗是有效的主要程序,假设负重延迟六周以保护软组织和手术切口。
■四级,回顾性病例系列。
UNASSIGNED: Among diabetics, patients with peripheral neuropathy are at increased risk of developing complications following an ankle fracture. While the outcomes in these patients treated nonoperatively have been poor, the outcomes in those undergoing open reduction and internal fixation are at the best modest. We hypothesize that closed reduction and internal fixation with tibiotalocalcaneal nail is an effective primary procedure in this complication prone patient group.
UNASSIGNED: A retrospective review of diabetic patients with peripheral neuropathy who underwent acute treatment of an ankle fracture with closed reduction and internal fixation with a tibiotalocalcaneal nail at two Level 1 trauma centers was performed. 30 patients were identified and divided into 2 groups with respect to their postoperative weight bearing protocol: 20 patients in the early weight bearing (EWB) group and 10 patients in the touch-down weight bearing (TDWB). The primary outcome was the rate of return to baseline function and the secondary outcomes included the incidence of wound dehiscence, wound infection, implant failure, loss of fixation, loss of reduction and amputation.
UNASSIGNED: In the EWB group, 15/20 patients returned to their baseline function, 5/20 had wound dehiscence and infection, 2/20 had implant failure, 5/20 had loss of fixation, 4/20 had loss of reduction, and 4/20 underwent amputation. In the TDWB group, 9/10 patients returned to their baseline function, 1/10 had implant failure, 1/10 had loss of fixation. No patients from this group had loss of reduction or underwent amputation.
UNASSIGNED: Treatment with tibiotalocalcaneal nail is an effective primary procedure in this complication prone group of patients, assuming that weight bearing is delayed for six weeks to protect soft tissues and surgical incisions.
UNASSIGNED: Level IV, retrospective case series.