Journal of Foot and Ankle Surgery - 2026-04-06 - Journal Article
The Impact of Diabetes Mellitus on Postoperative Outcomes Following Open Reduction and Internal Fixation (ORIF) of Open Ankle Fractures.
Mitchell LH, Pollard JD, Weintraub MLR, Parker MM, Doyle MD, Castellucci-Garza FM
Topics
Key Takeaway
Diabetes mellitus increases deep infection risk 5.4-fold and nonunion risk 2.67-fold after ORIF of open ankle fractures, with complicated DM driving deep infection risk to 7.67-fold versus non-diabetic patients.
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Summary
This study asked whether DM severity independently predicts postoperative complications after ORIF of open ankle fractures using adjusted relative risk models controlling for age, sex, race/ethnicity, and BMI in 235 patients. DM patients had significantly higher rates of deep infection (RR 5.40), nonunion (RR 2.67), and delayed laceration healing beyond 3 weeks (RR 1.36). Complicated DM amplified all risks further, with deep infection RR reaching 7.67 and nonunion RR 3.16 compared to non-diabetic controls.
Key Limitation
Gustilo-Anderson grade distribution across diabetic and non-diabetic cohorts is not reported, leaving open fracture severity as a potential uncontrolled confounder driving the observed complication differences.
Original Abstract
BACKGROUND
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.
PURPOSE
To evaluate whether DM is associated with increased postoperative complications after ORIF of open ankle fractures and whether outcomes differ by diabetes severity.
STUDY DESIGN
Retrospective cohort study.
METHODS
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.
RESULTS
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).
CONCLUSION
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.