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Current Concepts Review   |    
The Management of Ankle Fractures in Patients with Diabetes
Dane K. Wukich, MD1; Alex J. Kline, MD2
1 University of Pittsburgh Medical Center Comprehensive Foot and Ankle Center, Roesch-Taylor Building, Suite 7300, 2100 Jane Street, Pittsburgh, PA 15203. E-mail address: wukichdk@upmc.edu
2 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jul 01;90(7):1570-1578. doi: 10.2106/JBJS.G.01673
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Abstract

Patients with diabetes mellitus have higher complication rates following both open and closed management of ankle fractures.

Diabetic patients with neuropathy or vasculopathy have higher complication rates than both diabetic patients without these comorbidities and nondiabetic patients.

Unstable ankle fractures in diabetic patients without neuropathy or vasculopathy are best treated with open reduction and internal fixation with use of standard techniques.

Patients with neuropathy or vasculopathy are at increased risk for both soft-tissue and osseous complications, including delayed union and nonunion. Careful soft-tissue management as well as stable, rigid internal fixation are crucial to obtaining a good outcome.

Prolonged non-weight-bearing and subsequently protected weight-bearing are recommended following both operative and nonoperative management of ankle fractures in patients with diabetes.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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