The impact of diabetes mellitus on postoperative outcomes following open reduction and internal fixation (ORIF) of open ankle fractures.

Abstract

Open ankle fractures are complex injuries with high complication rates. Diabetes mellitus (DM) is associated with adverse outcomes after ankle fracture surgery, but limited data directly compare postoperative outcomes following ORIF of open ankle fractures in patients with versus without DM. To evaluate whether DM is associated with increased postoperative complications after ORIF of open ankle fractures and whether outcomes differ by diabetes severity. Retrospective cohort study. Demographic, perioperative, and postoperative data were collected for patients undergoing ORIF of open ankle fractures. Adjusted RR models controlling for age, sex, race/ethnicity, and body mass index compared outcomes between patients with and without DM and between uncomplicated and complicated DM. Outcomes were assessed for ≥3 months or until documented healing. Of 235 patients, 56 (23.8%) had DM. Compared with nondiabetic patients, those with DM had higher risks of deep infection (RR = 5.40; 95% CI: 1.38-21.10), delayed laceration healing >3 weeks (RR = 1.36; 95% CI: 1.04-1.77), and nonunion (RR = 2.67; 95% CI: 1.29-5.56). Complicated DM further increased risks of deep infection (RR = 7.67; 95% CI: 1.51-38.79), wound complications (RR = 1.54; 95% CI: 1.08-2.19), delayed laceration healing (RR = 1.40; 95% CI: 1.04-1.88), and nonunion (RR = 3.16; 95% CI: 1.41-7.08). DM-particularly complicated DM-is associated with markedly higher risks of infection, delayed healing, and nonunion after ORIF of open ankle fractures. These findings highlight the importance of vigilant perioperative management and consideration of diabetes related disease severity.