Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 9 , ISSUE S1 ( August, 2022 ) > List of Articles

Original Article

Salvage Technique for Failed ORIF in Diabetic Ankle Fractures: A Case Series

Ari R Berg, Nicholas F Cuppari, Mohamed Rupani, Sheldon Lin

Keywords : Ankle external fixator, Diabetic ankle, Diabetic ankle fracture, Failed ankle ORIF, Salvage ankle ORIF, Tibiotalocalcaneal fusion

Citation Information : Berg AR, Cuppari NF, Rupani M, Lin S. Salvage Technique for Failed ORIF in Diabetic Ankle Fractures: A Case Series. J Foot Ankle Surg Asia-Pacific 2022; 9 (S1):S168-S172.

DOI: 10.5005/jp-journals-10040-1212

License: CC BY-NC 4.0

Published Online: 29-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: This study describes a treatment algorithm for addressing failed ankle open reduction and internal fixation (ORIF) in diabetic patients using two successful patient cases. Background: The complication rate following ankle fracture ORIF in diabetic patients is significantly higher compared to that in nondiabetic patients and salvage techniques are limited. Complications include soft tissue problems and increased infection rate, impaired bone healing and the possibility of a lost reduction, and Charcot arthropathy. Case description: We analyze two cases of failed ORIF following traumatic ankle fracture in diabetic patients. Both patients underwent salvage procedures utilizing skinny wire external fixators with tibiotalocalcaneal stabilization via one or two Steinmann pins and were initiated on an 8-week course of IV antibiotics. Conclusion: Use of external fixation with tibiotalocalcaneal Steinmann pin fixation and IV antibiotics is an effective treatment after failed ankle ORIF in diabetic patients. Clinical significance: An algorithm to salvage failed ankle ORIF can help avoid the worst outcomes in diabetic patients.

PDF Share
  1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a Review. Injury 2006;37(8):691–697. DOI: 10.1016/j.injury.2006.04.130
  2. Gougoulias N, Oshba H, Dimitroulias A, et al. Ankle fractures in diabetic patients. EFORT Open Rev 2020;5(8):457–463. DOI: 10.1302/2058-5241.5.200025
  3. Loder RT. The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res 1988;(232):210–216. ISSN: 0009-921X, 0009-921X; PMID: 3289812.
  4. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma 1999;13(5):369-372. DOI: 10.1097/00005131-199906000-00008
  5. Stuart MJ, Morrey BF. Arthrodesis of the diabetic neuropathic ankle joint. Clin Orthop Relat Res 1990;(253):209–211. ISSN: 0009-921X, 0009-921X; PMID: 2317976.
  6. Kline AJ, Gruen GS, Pape HC, et al. Early complications following the operative treatment of pilon fractures with and without diabetes. Foot Ankle Int 2009;30(11):1042–1047. DOI: 10.3113/FAI.2009.1042
  7. Wukich DK, Joseph A, Ryan M, et al. Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes. Foot Ankle Int 2011;32(2):120–130. DOI: 10.3113/FAI.2011.0120
  8. Schmidt T, Simske NM, Audet MA, et al. Effects of diabetes mellitus on functional outcomes and complications after torsional ankle fracture. J Am Acad Orthop Surg 2020;28(16):661–670. DOI: 10.5435/JAAOS-D-19-00545
  9. Pincus D, Veljkovic A, Zochowski T, et al. Rate of and risk factors for intermediate-term reoperation after ankle fracture fixation: A population-based cohort study. J Orthop Trauma 2017;31(10):e315–e320. DOI: 10.1097/BOT.0000000000000920
  10. Facaros Z, Ramanujam CL, Stapleton JJ. Combined circular external fixation and open reduction internal fixation with pro-syndesmotic screws for repair of a diabetic ankle fracture. Diabet Foot Ankle 2010;1. DOI: 10.3402/dfa.v1i0.5554
  11. Jani MM, Ricci WM, Borrelli J Jr, et al. A protocol for treatment of unstable ankle fractures using transarticular fixation in patients with diabetes mellitus and loss of protective sensibility. Foot Ankle Int 2003;24(11):838–844. DOI: 10.1177/107110070302401106
  12. Vaudreuil NJ, Fourman MS, Wukich DK. Limb salvage after failed initial operative management of bimalleolar ankle fractures in diabetic neuropathy. Foot Ankle Int 2017;38(3):248–254. DOI: 10.1177/1071100716676063
  13. Guerrero-Maestre RG, Beaton-Comulada D, Colon-Miranda R. Hindfoot fusion nail with adjuvant hybrid external fixation used as limb-salvage procedure after failed open reduction internal fixation of ankle fracture in a charcot joint: a case report. P R Health Sci J 2018;37(4):235–238. PMID: 30548061.
  14. Coughlin MJ, Grimes JS, Traughber PD, et al. Comparison of radiographs and CT scans in the prospective evaluation of the fusion of hindfoot arthrodesis. Foot Ankle Int 2006;27(10):780–787. DOI: 10.1177/107110070602701004
  15. Frey C, Halikus NM, Vu-Rose T, et al. A review of ankle arthrodesis: predisposing factors to nonunion. Foot Ankle Int 1994;15(11):581–584. DOI: 10.1177/107110079401501102
  16. Chou LB, Mann RA, Coughlin MJ, et al. Stress fracture as a complication of autogenous bone graft harvest from the distal tibia. Foot Ankle Int 2007;28(2):199–201. DOI: 10.3113/fai.2007.0199
  17. Boone DW. Complications of iliac crest graft and bone grafting alternatives in foot and ankle surgery. Foot Ankle Clin 2003;8(1):1–14. DOI: 10.1016/s1083-7515(02)00128-6
  18. Kirmeier R, Payer M, Lorenzoni M, et al. Harvesting of cancellous bone from the proximal tibia under local anesthesia: donor site morbidity and patient experience. J Oral Maxillofac Surg 2007;65(11):2235–2241. DOI: 10.1016/j.joms.2006.11.038
  19. DiGiovanni CW, Lin SS, Baumhauer JF, et al. Recominant human platelet-derived growth factor-BB and beta-tricalcium phosphate (rhPDGF-BB/B-TCP): an alternative to autogenous bone graft. J Bone Joint Surg Am 2013;95(13):1184–1192. DOI: 10.2106/JBJS.K.01422
  20. Digiovanni CW, Baumhauer J, Lin SS, et al. Prospective, randomized, multi-center feasibility trial of rhPDGF-BB versus autologous bone graft in a foot and ankle fusion model. Foot Ankle Int 2011;32(3):344–354. DOI: 10.3113/FAI.2011.0344
  21. Daniels T, DiGiovanni C, Lau JT, et al. Prospective clinical pilot trial in a single cohort group of rhPDGF in foot arthrodeses. Foot Ankle Int 2010;31(6):473–479. DOI: 10.3113/FAI.2010.0473
  22. Daniels TR, Anderson J, Swords MP, et al. Recombinant human platelet-derived growth factor BB in combination with a beta-tricalcium phosphate (rhPDGF-BB/beta-TCP)—collagen matrix as an alternative to autograft. Foot Ankle Int 2019;40(9):1068–1078. DOI: 10.1177/1071100719851468
  23. Daniels TR, Younger AS, Penner MJ, et al. Prospective randomized controlled trial of hindfoot and ankle fusions treated with rhPDGF-BB in combination with a beta-TCP-collagen matrix. Foot Ankle Int 2015;36(7):739–748. DOI: 10.1177/1071100715576370
  24. Berlet GC, Baumhauer JF, Glazebrook M, et al. The impact of patient age on foot and ankle arthrodesis supplemented with autograft or an autograft alternative (rhPDGF-BB/beta-TCP). JB JS Open Access 2020;5(4):e20.00056. DOI: 10.2106/JBJS.OA.20.00056
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.