Diabetic Neuropathy is an Independent Risk Factor for Poor Orthopedic Outcomes Following Operatively Treated Ankle Fractures

Objectives: To investigate the impact of diabetic neuropathy on operative bimalleolar or trimalleolar ankle fracture outcomes when compared with both non-diabetic and diabetic patients without neuropathy. METHODS: Design: Retrospective comparative study. Setting: TriNetX research network, a global health-collaborative clinical research platform comprising de-identified electronic health records from healthcare 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 to both non-diabetics 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. Following matching, logistic regression was performed to calculate risk ratios and assess differences in postoperative medical and surgical complications between neuropathic and non-diabetic patients, as well as between neuropathic and diabetic patients. Results: Included were 115,162 ankle fracture patients; 94,111 (81.7%) patients without diabetes, 13,741 (12%) patients with diabetes but without diabetic neuropathy, and 7,310 (6.3%) patients with diabetic neuropathy. When compared to patients without diabetes, patients with diabetic neuropathy had increased risk of two-year malunion/nonunion (Risk ratio (RR) 1.79; p<0.001), implant infection (RR 2.12; p<0.001) and amputation (RR 8.01; p<0.001). When compared to 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). Conclusion: This study found that patients with diabetic neuropathy had higher odds of postoperative complications, such as malunion/nonunion, infection, and amputation, following surgical fixation of ankle fractures than non-diabetic patients and diabetic patients without neuropathy.