If you are a diabetic, try not to fracture an ankle. Research led by Kenneth A. Egol, M.D., of the Department of Orthopaedic Surgery at New York University, found that diabetics who undergo ankle fracture surgery have significantly longer lengths of stay and higher hospital charges compared to non-diabetics. And they discovered even worse trends among patients with complicated disease.
Diabetes Hampers Recovery From Ankle Surgery

The researchers looked at nearly 59, 000 individuals who underwent open reduction and internal fixation (ORIF) surgery to fix an ankle fracture. They took their cases from the data base of the New York Statewide Planning and Research Cooperative System. About 7, 500 of the patients had diabetes. Nearly 1, 100 of them had the complicated disease that caused renal or neurologic manifestations.
The researchers found that patients with diabetes were more likely to incur significantly greater hospital charges ($26, 491 for a patient with diabetes versus $20, 428 for a non-diabetic ) and have significantly longer lengths of hospital stay (5.8 days for diabetes compared with 3.9 days for non-diabetes). The investigators saw a similar trend when patients with complicated diabetes were compared to patients with diabetes alone.
“With increasing U.S. diabetes rates, more orthopaedic surgeons are faced with treating the unique needs of patients in this population.” said Egol. “Better understanding of the complications and care considerations among diabetics could allow health care professionals better manage and treat this growing group of patients and keep down medical costs.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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