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Diabetes, vascular disease increase amputation risk after ORIF for ankle fracture
Meticulous postoperative care of those with diabetes may prevent future complications.
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A database study found diabetes mellitus and peripheral vascular disease put patients operated on for ankle fracture at an increased risk of wound infections, revisions and amputations.
“Both complicated and uncomplicated diabetes show significantly increased risk of adverse events,” said Lucie Krenek, MD. “This suggests that even patients whose diabetes is well-controlled and who have no sequelae from the disease are at significantly increased risk of significant complications.”
She presented these findings at the American Academy of Orthopaedic Surgeons annual meeting.
The study revealed an odds ratio of 27.63 for below the knee amputation (BKA) in patients with complicated diabetes and odds ratios for wound infections and revision of open reduction internal fixation (ORIF) surgery in diabetic patients of 3.85 and 5.09, respectively.
Diverse data sample
The researchers studied more than 57,000 patients in the California discharge database who had a lateral malleolar, bimalleolar or trimalleolar ankle fracture treated surgically from 1999 to 2005.
Among them, 2% had complicated diabetes with end organ damage, 8% had uncomplicated diabetes and 1% had peripheral vascular disease (PVD).
Because researchers used a large state-based database the overall sample was socioeconomically and ethnically diverse, Krenek said the study relied on logistic regression models to study how diabetes and PVD affect risks for each adverse event.
Use meticulous care
“Overall rates of complications in the entire patient sample were low,” Krenek said.
“Results of this study suggest the risk of adverse events in patients with diabetes or PVD is very high, particularly for those with complicated diabetes,” Krenek said. This rate is also high for patients with uncomplicated diabetes, a group that has not been well-studied previously, which suggests these patients have a high risk of complications as well.
She said using the database was the study’s main limitation.
During the discussion period, Krenek recommended physicians not ignore patients with uncomplicated diabetes because they perceive them as having a low risk of infections and other complications. “These patients require the same type of meticulous care as do patients with significant complications from diabetes,” she said.
For more information:
- Nelson F. Soohoo, MD, the senior author of the study, can be reached at the University of California Los Angeles School of Medicine, 10945 Le Conte Ave., Room 33-55, Los Angeles, CA 90095; 310-267-5299; e-mail: Nsoohoo@mednet.ucla.edu. The authors have no direct financial interest in any products or companies mentioned in this article.
Reference:
- SooHoo NF, Krenek L, Eagan M, et al. Complications following treatment of ankle fractures in patients with diabetes or vascular disease. #490. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.