|
Year |
2003 |
|---|---|
|
Question Number |
54. |
|
Category |
Musculoskeletal Trauma |
Question
A 52-year-old man sustains a displaced bimalleolar (Weber B) ankle fracture in a
fall. History reveals that he has had type I diabetes mellitus for the past 30 years. Examination reveals a closed injury with mild swelling, palpable pulses, and decreased sensation to the midcalf level. Management should consist of
1- closed treatment with a short leg cast
2- percutaneous pin-in-plaster technique
3- external fixation spanning the ankle
4- amputation
5- open reduction and internal fixation of the medial and lateral malleoli
Figures
Answer (click for answer)
Answer: 5
11 treated closed reduction + cast
6 diabetics: 4/6 (67%) became infected, 1 med mall nonunion
5 nondiabetics: 0/5 infected
87 treated ORIF
19 diabetics: 4/19 (21%) infected
68 nondiabetics: 6/68 (9%) infected
• Overall diabetics have 32% risk of infxn compared to 8% for nondiabetics treated for closed ankle fracture (surgical and nonsurgical)
• Significantly higher risk of infection among diabetics treated with closed reduction & immobilization vs ORIF
• Significant RFs among diabetic group for development of subsequent infection
Peripheral neuropathy
Peripheral vascular disease
Cast immobilization
Reference: Flynn et al. Closed ankle fractures in the diabetic patient. Foot Ankle Int 2000; 20: 311-319.