Ankle Fractures in Diabetes Mellitus: A Narrative Review of Pathophysiology, Management, and Complications

The combination of neuropathy, vasculopathy, and impaired bone repair makes ankle fractures in people with diabetes mellitus a serious clinical concern. Complications, including infection, nonunion, Charcot neuroarthropathy, and even amputation, are more likely to occur in these individuals. This chapter analyses the biochemical and physiological impacts of diabetes on bone health and recovery, reviews specific assessment and evaluation methods for affected patients, and delineates both nonsurgical and surgical treatment alternatives. This study evaluates various surgical techniques, including standard, trans-syndesmotic, transarticular, hybrid fixation, and primary arthrodesis, within the framework of diabetic conditions. The significance of selecting a suitable fixation technique, evaluating vascular health, and utilising a multidisciplinary approach is highlighted. In addition, this chapter discusses complications such as Charcot arthropathy, fixation failure, and infection. The objective is to provide orthopaedic surgeons and clinicians with a practical, evidence-based guide for the effective management of diabetic ankle fractures.