Ankle fractures in patients with
diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing,
infection, malunion, delayed union, nonunion, and Charcot
arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic
ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic
ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle
arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced
ankle fractures. Several techniques have been described to minimize complications associated with diabetic
ankle fractures (eg, rigid external fixation, use of
Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.