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Fractures and dislocations of the foot and ankle in people with diabetes: a literature review

Authors :
Matthew J. Johnson
Suganthi Kandasamy
Katherine M. Raspovic
Kshitij Manchanda
George Tye Liu
Michael D. VanPelt
Lawrence A. Lavery
Dane K. Wukich
Source :
Therapeutic Advances in Endocrinology and Metabolism, Vol 14 (2023)
Publication Year :
2023
Publisher :
SAGE Publishing, 2023.

Abstract

Diabetes (DM) increases fracture risk, and bone quality depends on type diabetes type, duration, and other comorbidities. Diabetes is associated with a 32% increased relative risk (RR) of total fractures and 24% increased RR of ankle fractures compared with patients without DM. Type 2 DM is associated with a 37% increased RR of foot fractures compared with patients without DM. The incidence of ankle fractures in the general population is 169/100,000 per year, while foot fractures occur less frequently, with an incidence of 142/100,000 per year. Biomechanical properties of bone are negatively impacted by stiff collagen, contributing to the increased risk of fragility fractures in patients with DM. Systemic elevation of proinflammatory cytokines, such as tumor necrosis factor-alpha (TNFα), interleukin-1β (IL-1β), and interleukin 6 (IL-6), impact bone healing in patients with DM. Fractures in patients with DM, can be associated with poorly regulated levels of RANKL (receptor activator of nuclear transcription factor kappa-b ligand) leading to prolonged osteoclastogenesis, and net bone resorption. One of the most salient factors in treating fractures and dislocations of the foot and ankle is to recognize the difference between patients with uncomplicated and complicated DM. Complicated diabetes is defined as ‘end organ damage’, and for the purposes of this review, includes patients with neuropathy, peripheral artery disease (PAD) and/or chronic renal disease. Uncomplicated diabetes is not associated with ‘end organ damage’. Foot and ankle fractures in patients with complicated DM pose challenges, and surgery is associated with increased risks of impaired wound healing, delayed fracture healing, malunion, infection, surgical site infection, and revision surgery. While patients with uncomplicated DM can be treated like patients without DM, patients with complicated DM require close follow-up and robust fixation methods should be considered to withstand the anticipated prolonged healing period. The aims of this review are as follows: (1) to review pertinent aspects of DM bone physiology and fracture healing, (2) to review the recent literature on treatment of foot and ankle fractures in patients with complicated DM, and (3) to provide treatment protocols based on the recent published evidence.

Details

Language :
English
ISSN :
20420196 and 20420188
Volume :
14
Database :
Directory of Open Access Journals
Journal :
Therapeutic Advances in Endocrinology and Metabolism
Publication Type :
Academic Journal
Accession number :
edsdoj.2bdf1f532c314751a2222380c386ab00
Document Type :
article
Full Text :
https://doi.org/10.1177/20420188231163794