SLR - October 2017 - Anne M. Maestas; Robert A. Djali

Fluoroscopy-Guided Reduction and Fibular Nail Fixation to Manage Unstable Ankle Fractures in Patients with Diabetes: A Retrospective Cohort Study

Reference: Ashman BD, Kong C, Wing KJ, Penner MJ, Bugler KE, White TO, Younger AS. Fluoroscopy-Guided Reduction and Fibular Nail Fixation to Manage Unstable Ankle Fractures in Patients Living with Diabetes: A Retrospective Cohort Study. JBJS. 2016 Sept;98-B(9):1197–201.

Scientific Literature Review

Reviewed By: Anne M. Maestas, DPM; Robert A. Djali, DPM
Residency Program: SSM Health DePaul Hospital, St. Louis, MO

Podiatric Relevance: Podiatric surgeons often treat ankle fractures in the diabetic population. However, wound-healing complications are prevalent during the postoperative course and can lead to detrimental outcomes, including loss of limb or life. This study describes a less invasive approach to fixating unstable ankle fractures and decreasing the subsequent risk of wound-healing complications.

Methods: This is a level IV retrospective review of Type I and Type II diabetic patients with Weber B or C fibular fractures. These patients underwent fluoroscopic-guided reduction and percutaneous fracture fixation with a fibular nail. Twenty-four patients were enrolled; the outcomes were determined and evaluated.

Results: Twenty-four patients met the inclusion criteria and were deemed to be at risk for developing wound complications. The authors determined that 16.7 percent of the patients experienced wound dehiscence with 8.3 percent progressing to infections; 4.2 percent of the infection cases underwent additional surgery for irrigation and debridement (one patient). A total of 16.7 percent of patients required reoperation for removal of symptomatic screws (three patients) or debridement and irrigation of the wound (one patient). Patients requiring hardware removal; however, retained the fibular nail. There was reported to be a 25 percent mortality rate for reasons unrelated to the ankle fracture or surgery. There was a zero percent rate of limb loss. A total of 70.8 percent of patients participated in a Short Form-36 Mental Component Score and Physical Component score with results of 53.2 (Confidence interval 95 percent at 48.1 to 58.4) and 39.3 (95 percent Confidence interval at 32.1 to 46.4), respectively. 45.8 percent of patients participated in the Visual Analog Scale for pain, 3.1 out of 10 (Confidence interval 95 percent at 1.4 to 4.9) and Ankle Osteoarthritis Scale, 32.9 (Confidence interval 95 percent at 16.0 to 49.7)

Conclusion: The treatment of unstable diabetic fibular fractures with fluoroscopic guidance and percutaneous fibular nailing is associated with a low incidence of complication. This technique allows for a stable fixation construct with favorable functional outcomes in high-risk diabetic patients.

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