Ankle Fractures in the Complex Diabetic Patient. Minimally Invasive Surgery and Augmentation with Ring Fixation

Category: Diabetes; Trauma Introduction/Purpose: Ankle fractures in complex diabetic patients (target organ damage, obesity, and HBA1C > 8 mg/dl) are associated with serious complications. Good results have been reported with MIS techniques in patients at risk of soft tissue complications and with the use of early containment frames in patients with diabetic neuroarthropathy. Our objective was to evaluate a novel, minimally invasive management protocol with augmentation using ring external fixation. Methods: Retrospective IRB approved study including 18 complicated diabetic patients with bi- or trimalleolar ankle fractures with a minimum follow-up of one year. Fibular intramedullary fixation was performedand percutaneous screws were used for the medial and posterior malleolar fractures. The stability of the construct was increased by using a ring external fixator. Demographic data, AOFAS scores, and Lower Extremity Functional Score (LEFS) functional scales were obtained, as well as a record of complications during the complete follow-up and visual analog scale (VAS). Results: The mean age and HBA1C were 56 years (R:37-73) and 9.8 ± 2.5 mg/dl. The external fixator time was 12.3 weeks (6-28) with complete healing in of 16/18 patients (89%) at 12.6 weeks (R:8-24). The average AOFAS was 79 (R:67-97), LEFS was 61.8% (R37.5-90). The mean postoperative VAS score was 4.4/10. The most frequent complication was superficial pin infections (38.8%) and there was one case of secondary Charcot Neuroarthropathy. No deep infections or wound dehiscence was observed. Conclusion: This minimally invasive fixation technique with augmentation is a safe alternative for complex diabetic patients with poor metabolic control and high HBA1C values. In our patients, we achieved high union rates according to what is reported in the literature, with a low incidence of major complications and acceptable functional results. Percutaneous fixation and ring augmentation