Outcomes of Surgically Treated Pilon Fractures: A Comparison of Patients With and Without Diabetes

Abstract

Objective: To compare systemic complications, fracture healing–related complications, and reoperation rates for pilon fractures in patients with and without diabetes. Design: Retrospective cohort study. Setting: National administrative claims database with patient records. Patients: Patients from the years 2016 to 2020 with surgically treated closed or open pilon fractures were included. Intervention: Patients with either closed or open pilon fractures with diabetes were compared with those without diabetes. Subgroup analysis was performed on diabetic patients with and without neuropathy. Outcomes: Postoperative systemic complications at 90 days, fracture healing complications at 90 days and 1 year, and reoperative rates at 90 days and 1 year. Results: Two thousand six hundred fifty-four (31.4%) patients with closed fractures and 491 (28.7%) patients with open fractures had a diagnosis of diabetes. In both open and closed fractures, we identified significantly higher rates of acute kidney injury, cardiac arrest, and surgical site infection in diabetic patients compared with nondiabetic patients. In addition, we found significantly higher rates of below knee amputations in diabetic patients. Diabetic patients with closed fractures had significantly higher rates of wound healing–related reoperations. Patients with advanced diabetic disease, as suggested by the presence of neuropathy, had higher rates of nonunion and post-traumatic arthritis. Conclusions: The data presented here provide updated estimates on complication rates in pilon fractures using a large sample size. In addition, our work identifies differences in outcomes for patients with and without diabetes after pilon fracture surgery. Our data suggest that patients with severe diabetes are prone to higher rates of healing complications and may benefit from additional therapeutic support. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.