Limb Salvage after Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy

Nicholas J. Vaudreuil, Mitchell S. Fourman, Dane K. Wukich

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. Methods: This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. Results: The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. Conclusion: This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level of Evidence: Level III, retrospective case series.

Original languageEnglish (US)
Pages (from-to)248-254
Number of pages7
JournalFoot and Ankle International
Volume38
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Ankle Fractures
Limb Salvage
Diabetic Neuropathies
Ankle Joint
Peripheral Nervous System Diseases
Diabetes Mellitus
External Fixators
Arthrodesis
Nails
Infection
Amputation
Outcome Assessment (Health Care)
Bone and Bones

Keywords

  • ankle fracture
  • arthrodesis
  • diabetes
  • failed fixation
  • limb salvage
  • peripheral neuropathy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Limb Salvage after Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy. / Vaudreuil, Nicholas J.; Fourman, Mitchell S.; Wukich, Dane K.

In: Foot and Ankle International, Vol. 38, No. 3, 01.03.2017, p. 248-254.

Research output: Contribution to journalArticle

@article{d8082cef8c6c41bd97e91f06834a3954,
title = "Limb Salvage after Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy",
abstract = "Background: Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. Methods: This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. Results: The overall rate of limb salvage was 82.3{\%} (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. Conclusion: This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level of Evidence: Level III, retrospective case series.",
keywords = "ankle fracture, arthrodesis, diabetes, failed fixation, limb salvage, peripheral neuropathy",
author = "Vaudreuil, {Nicholas J.} and Fourman, {Mitchell S.} and Wukich, {Dane K.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1177/1071100716676063",
language = "English (US)",
volume = "38",
pages = "248--254",
journal = "Foot and Ankle International",
issn = "1071-1007",
publisher = "AOFAS - American Orthopaedic Foot and Ankle Society",
number = "3",

}

TY - JOUR

T1 - Limb Salvage after Failed Initial Operative Management of Bimalleolar Ankle Fractures in Diabetic Neuropathy

AU - Vaudreuil, Nicholas J.

AU - Fourman, Mitchell S.

AU - Wukich, Dane K.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background: Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. Methods: This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. Results: The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. Conclusion: This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level of Evidence: Level III, retrospective case series.

AB - Background: Ankle fractures in patients with diabetes mellitus (DM) can be difficult to manage, especially in the presence of peripheral neuropathy. In patients who fail initial operative management, attempts at limb salvage can be challenging, and no clear treatment algorithm exists. This study examined outcomes of different procedures performed for limb salvage in this population. Methods: This study retrospectively reviewed 17 patients with DM complicated by peripheral neuropathy who sustained a bimalleolar ankle fracture and failed initial operative management. Patients were treated with revision open reduction internal fixation (ORIF) (3/17), closed reduction external fixation (CREF) (8/17), or primary ankle joint fusion (3/17 tibiotalocalcaneal fusion with hindfoot nail [TTCN] and 3/17 with tibiotalar arthrodesis using plates and screws [TTA]). Median follow-up was 20 months. Results: The overall rate of limb salvage was 82.3% (14/17). All patients who went on to amputation presented with infection and were treated initially with CREF (3/3). All patients who achieved successful limb salvage ended up with a clinically fused ankle joint (14/14); 9 underwent a primary or delayed formal fusion and 5 had a clinically fused ankle joint at study conclusion after undergoing revision ORIF or CREF with adjunctive procedures. Conclusion: This small study suggests that in this complicated group of patients it is difficult to achieve limb salvage with an end result of a functional ankle joint. CREF can be a viable option in cases where underlying infection or poor bone quality is present. Treatment with revision ORIF frequently requires supplementary external fixator or tibiotalar Steinman pin placement for additional stability. All patients who underwent revision ORIF ended up with clinically fused ankle joints at the end of the study period. Primary fusion procedures (TTA, TTCN) were associated with a high rate of limb salvage and a decreased number of operations. Level of Evidence: Level III, retrospective case series.

KW - ankle fracture

KW - arthrodesis

KW - diabetes

KW - failed fixation

KW - limb salvage

KW - peripheral neuropathy

UR - http://www.scopus.com/inward/record.url?scp=85014449873&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014449873&partnerID=8YFLogxK

U2 - 10.1177/1071100716676063

DO - 10.1177/1071100716676063

M3 - Article

VL - 38

SP - 248

EP - 254

JO - Foot and Ankle International

JF - Foot and Ankle International

SN - 1071-1007

IS - 3

ER -