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Abstract Ankle fractures are of the most injuries presented to orthopedic surgeon. Diabetes mellitus is a common disease with its incidence increasing annually with ever-aging population. Orthopedic surgeon should beware of the special consideration recommended when managing these cases. The prevalence of peripheral neuropathy is high ranging from 19% to 50%. Peripheral neuropathy derives the ankle of its protective sensations making it more prone to injury. This may explain the fact that the prevalence of diabetic peripheral neuropathy is higher in patients undergoing ankle foot and ankle surgery than the general population. Peripheral neuropathy also increases the rates of complications of ankle fractures compared to the non-complicated diabetic,2 these complications includes infection, loss of fixation, charcot‟s neuropathy and even up to amputation. That‟s why historically there was a trend to avoid operating upon a diabetic ankle fracture with peripheral neuropathy. However non-operative management of unstable ankle fractures in this population resulted in a significant higher rate of complications than operative treatment, making the non-operative treatment questionable. Here the surgeon faces another question; what method of fixation to choose. There are many factors to consider, including age, general condition, fracture pattern and the soft tissue condition. There are many fixation options that include: standard fixation the more rigid transsyndesmotic tetra-cortical fixation, minimally invasive fixation, A Summary 94 percutaneous closed intramedullary nail, pin and bar external fixation and circular fixation and combined fixation . Peripheral neuropathy also requires special post-operative management of those ankle fractures. It requires longer period of nonweight-bearing and the protection with walking cast after weight-bearing has begun. Diabetes also appears to dramatically increase the risk of lower extremity amputation because of infected, non-healing foot ulcers. The rates of amputation in diabetic populations are typically10 to 20 times those of non-diabetic individuals and over the past decade have ranged from 1.5to 3.5 events per 1000 persons per year in populations with diagnosed diabetes. The main aim of this study was to evaluate the radiological and clinical outcome of operative treatment of ankle fractures in diabetic patients. This prospective study was conducted on 21 diabetic patients with ankle fractures managed operatively, at least half of these cases were operated on the orthopedic department of Menoufia University hospital and the rest of the cases were operated on ELSheikh Zayed ALnahyan Hospital. Summary 95 The main results of the study revealed that: The mean age was 51.5 ± 9.2 years old (range, 35 – 66 years old). Patients were classified into three age groups: less than 40 (n = 3), between 40 and 60 (n = 13), and more than 60 years old (n = 5). The mean BMI was 35.6 ± 3.4 Kg/m2 (range, 30 – 42). All included patients were obese. Eight (38%) patients were mildly obese (class I), 10 (48%) patients were moderately (obese) class II, and three (14%) patients were morbidly obese (class III). The mean duration of DM was 9.1 ± 3.6 years (range, 3 – 15 years). Eight (38%) patients were found to be insulin dependent. The mean values for laboratory measurements were within normal ranges. The mean value of HbA1c was 7.8% ± 0.8% (range, 7% – 9%). The mean blood glucose level was 159.3 ± 23.3 mg/dl (range, 120 – 197 mg/dl). The mean level of serum creatinine was 1.29 ± 0.4 mg/dl (range, 1 – 2 mg/dl). Nine (43%) of the fractures were low-energy trauma resulting from twisting injuries; three had slipped on the ground, four had stumbled in a staircase, and two were minor bicycle accidents. Eight fractures were caused by RTA, and four had occurred when falling from height and were thereby classified as high-energy trauma. In twelve (57%) cases, the left ankle was injured. A statistically significant improvement in ankle scores was found between the two follow-ups (Paired sample t test, P = .000). Summary 96 Some sort of pain was reported from 11 (52%) subjects at 6 months and from eight (38%) after 12 months, especially while walking on uneven surface. Four (19%) patients experienced stiffness that did not improve at 12-month follow-up. Seven (33%) patients complained of ankle swelling at 6 months, where only two had their ankle swelling resolved at 12 months. Thirteen (62%) and 10 (48%) patients had reduced activities of daily living compared to pre-injury after 6 and 12 months, respectively. When comparing complication rates between complicated DM and non-complicated DM, patients with associated diabetic comorbidities were found to have a significantly higher incidence of postoperative adverse events. Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion |