Diabetes is a risk factor for complications related to displaced ankle fractures. Limited literature exists comparing complication rates in nonoperative versus operative treatment of displaced ankle fractures in diabetics. No study has highlighted the natural history of nonoperative treatment of displaced ankle fractures in diabetics.

We retrospectively reviewed all adult ankle fractures from September 2011 through December 2014. Inclusion was limited to ambulatory adults (>18 years) with closed, displaced (widened mortise) ankle fractures with diabetes mellitus. Nonoperative treatment consisted of closed reduction and casting. Fractures were classified according to the Lauge-Hansen and AO-Weber classification systems. All operative fractures underwent open reduction internal fixation (ORIF) within 3 weeks of injury. Functional outcomes and complication rates were compared. Of 28 displaced diabetic ankle fractures, 20 were treated nonoperatively (closed reduction and casting) and 8 operatively (ORIF within 3 weeks of injury). Mean follow-up was 7 months (range 3-18 months).

Age, insulin-dependent diabetes, and AO type B fracture rate were similar in nonoperative and operative cohorts, but fracture dislocation rate was significantly higher among operative fractures (87.5% vs 40%; P = .04). Nonoperative treatment was associated with a 21-fold increased odds of complication compared with operative treatment (75% vs 12.5%, OR 21.0, P = .004). Complication rate following unintended ORIF for persistent nonunion or malunion in nonoperatively treated patients was significantly greater compared with immediate ORIF (100% vs 12.5%, P = .005).

Nonoperative treatment of displaced diabetic ankle fractures was associated with unacceptably high complication rates when compared to operative treatment.

Level III, retrospective comparative series.

Polls results

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
83% Article relates to my practice (5/6)
0% Article does not relate to my practice (0/6)
16% Undecided (1/6)

Will this article lead to more cost-effective healthcare?

66% Yes (4/6)
33% No (2/6)
0% Undecided (0/6)

Was this article biased? (commercial or personal)

0% Yes (0/6)
100% No (6/6)
0% Undecided (0/6)

What level of evidence do you think this article is?

0% Level 1 (0/6)
0% Level 2 (0/6)
83% Level 3 (5/6)
16% Level 4 (1/6)
0% Level 5 (0/6)