Glycated hemoglobin as a predictive factor for postoperative outcome in controlled versus uncontrolled diabetic patients with ankle fractures

Abstract

Background Ankle fracture in diabetic patients is a challenging condition owing to the inherent risk of complications with either operative or nonoperative treatment. However, operative treatment is considered the gold standard treatment for such cases. In this study, the hypothesis is that the glycated hemoglobin (HbA1c) could have a predictive value for postoperative outcomes and complications. Patients and methods A total of 34 diabetic patients with ankle fractures were included in this study. The patients are divided into two groups: the first group included patients with controlled diabetes (HbA1c<7) and the second group included patients with uncontrolled diabetes (HbA1c≥7). All patients were treated by standard open reduction and internal fixation. Results The complications rate was higher in the uncontrolled diabetes group (63.2%) than in the controlled diabetes group (26.6%). Preoperative HbA1c was higher in complicated patients than in uncomplicated patients (P=0.033), and postoperative HbA1c was also higher in complicated patients than in uncomplicated patients (P=0.031). The postoperative American Orthopedic Foot and Ankle Society (AOFAS) score was significantly higher in the controlled diabetes group than in the uncontrolled diabetes group (P=0.046). Conclusion The overall rate of complications was higher in the uncontrolled diabetes group (HbA1c≥7) than in the controlled diabetes group (HbA1c<7), with a statistically significant difference. These complications were mainly related to wound healing. Despite being statistically insignificant, poor radiological outcome was more common in the uncontrolled diabetes group. According to the postoperative AOFAS score, clinical outcome was more superior in the controlled diabetes group than in the uncontrolled diabetes group.