Thordarson, David B MD
Diabetic patients who sustain displaced ankle fractures present a complex management problem for a surgeon. Patients without peripheral vascular disease or neuropathy can be managed in a similar fashion to other patients with standard open reduction and internal fixation techniques. In patients who are osteopenic or patients with confirmed diabetic neuropathy, more rigid methods of fixation should be employed. Patients with preoperative peripheral vascular disease should have a vascular consultation and, if necessary, a revascularization prior to fixation of the fracture. Failure of fixation in patients with diabetes with peripheral neuropathy can lead to Charcot arthropathy of the ankle. In general, patients with diabetes with ankle fractures require a minimum of twice the normal period of protected weight bearing during their healing. Despite the increased surgical risk, patients with diabetes with acute, displaced ankle fractures should undergo operative fixation.
Techniques in Foot & Ankle Surgery. 3(3):192-197, September 2004.