The Journal of Bone and Joint Surgery (American). 2008;90:1570-1578.
doi:10.2106/JBJS.G.01673
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Current Concepts Review

The Management of Ankle Fractures in Patients with Diabetes

Dane K. Wukich, MD1 and Alex J. Kline, MD2

1 University of Pittsburgh Medical Center Comprehensive Foot and Ankle Center, Roesch-Taylor Building, Suite 7300, 2100 Jane Street, Pittsburgh, PA 15203. E-mail address: wukichdk{at}upmc.edu
2 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Patients with diabetes mellitus have higher complication rates following both open and closed management of ankle fractures.

Diabetic patients with neuropathy or vasculopathy have higher complication rates than both diabetic patients without these comorbidities and nondiabetic patients.

Unstable ankle fractures in diabetic patients without neuropathy or vasculopathy are best treated with open reduction and internal fixation with use of standard techniques.

Patients with neuropathy or vasculopathy are at increased risk for both soft-tissue and osseous complications, including delayed union and nonunion. Careful soft-tissue management as well as stable, rigid internal fixation are crucial to obtaining a good outcome.

Prolonged non-weight-bearing and subsequently protected weight-bearing are recommended following both operative and nonoperative management of ankle fractures in patients with diabetes.


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