Diabetic Neuropathy Is an Independent Risk Factor for Poor Orthopaedic Outcomes After Operatively Treated Ankle Fractures.

OBJECTIVES

To investigate the impact of diabetic neuropathy on operative bimalleolar or trimalleolar ankle fracture outcomes when compared with both patients who are nondiabetic and patients who are diabetic without neuropathy.

DESIGN

Retrospective comparative study.

SETTING

TriNetX research network, a global health-collaborative clinical research platform comprising deidentified electronic health records from health care organizations across the United States.

PATIENT SELECTION CRITERIA: The TriNetX research network was queried for all patients with an operative bimalleolar or trimalleolar ankle fracture (OTA/AO 44) from 2005 to 2022. From this population, subgroups were formed based on diabetes status and the presence of diabetic neuropathy.

OUTCOME MEASURES AND COMPARISONS: Patients with diabetic neuropathy were compared with both patients who are nondiabetic and patients with diabetes. Propensity score matching (1:1) was performed to match patients based on demographics and comorbidities across groups, including severity of diabetes by A1C. After matching, logistic regression was performed to calculate risk ratios and assess differences in postoperative medical and surgical complications between patients who are neuropathic and patients who are nondiabetic, and between patients who are neuropathic and patients who are diabetic.

RESULTS

Included were 115,162 patients with ankle fracture; 94,111 (81.7%) patients without diabetes, 13,741 (12%) patients with diabetes but without diabetic neuropathy, and 7310 (6.3%) patients with diabetic neuropathy. When compared with patients without diabetes, patients with diabetic neuropathy had increased risk of 2-year malunion/nonunion (RR 1.79; P < 0.001), implant infection (RR 2.12; P < 0.001), and amputation (RR 8.01; P < 0.001). When compared with patients with diabetes, but without neuropathy, patients with diabetic neuropathy again had significantly higher odds of implant failure (RR 2.00; P < 0.001), malunion/nonunion (RR 2.35; P < 0.001), and infection (RR 2.25; P < 0.001).

CONCLUSIONS

This study found that patients with diabetic neuropathy had higher odds of postoperative complications, such as malunion/nonunion, infection, and amputation, after surgical fixation of ankle fractures than patients who are nondiabetic and patients who are diabetic without neuropathy.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.