The document summarizes a presentation on insights into diabetic foot and ankle injuries from Dr. Tahir Ögüt from Istanbul University. It notes that diabetes impairs bone healing and increases healing times for fractures. It outlines risks of complications for diabetic patients, including infection, delayed healing, and Charcot neuroarthropathy. The presentation discusses guidelines for nonoperative and operative treatment of fractures in diabetic patients, emphasizing immobilization, restricted weight bearing, soft tissue management, and rigid fixation to reduce complication rates. It presents several case studies in diabetic foot fracture treatment.

1. ANNUAL INTERNATIONAL EXTERNAL FIXATION
5th
SYMPOSIUM
December 2009, SAN ANTONIO, TX
EUROPEAN INSIGHTS IN NEUROPATHIC
FOOT AND ANKLE INJURIES
Tahir Ögüt, MD
Istanbul University
Cerrahpasa Medical Faculty
Department of Orthopaedics & Traumatology
Tahir OGUT Istanbul, TURKEY

2. SOME FACTS ABOUT DIABETIC FRACTURES
•Diabetes impairs bone healing
•Time to union in diabetic pts is 163% that of nondiabetics
•Neuropathic fx requires at least 3 additional months than controls
Loder RT, Clin Orthop 1988.
Boddenberg U. Zentralbl Chir 2004.
Tahir OGUT Istanbul, TURKEY

3. All diabetic foot & ankle fracture patients need to be informed
of potential increased complications:
•Wound healing problems
•Deep infection
•Delayed/nonunion
Charcot neuroarthropathy and peripheral vascular disease
play distinct roles in increasing these complication rates.
Tahir OGUT Istanbul, TURKEY

4. NONOPERATIVE TREATMENT
Immobilization and non-weight bearing are done for durations
of two to three times that of nondiabetic patients in an effort to
avoid malunion and Charcot arthropathy.
Charcot arthropathy can develop as a posttraumatic event
Tahir OGUT Istanbul, TURKEY

5. NONOPERATIVE TREATMENT
Closed treatment does not bar a patient from the risk of infection
•Noncompliance with diabetes treatment
Increases the
•Peripheral vascular disease
risk
•Peripheral neuropathy for infection
•Swelling in the
•Ecchymosis diabetic population
Tahir OGUT Istanbul, TURKEY

6. OPERATIVE FIXATION
In a review of 67 pts with ankle fractures (21 with diabetes),
the complication rate among the diabetics was 43%
compared with 15.5% in the nondiabetic group.
Complications in the diabetics included:
•5 deep infections
•3 losses of fixation
•2 below knee amputations
Blotter et al. Foot Ankle Int, 1999.
Tahir OGUT Istanbul, TURKEY

7. OPERATIVE FIXATION
Another review of 26 diabetic and 26 nondiabetic patients
with ankle fractures had 42% versus 0% complication rates,
respectively.
McCormack & Leith. J Bone Joint Surg Br, 1998.
Tahir OGUT Istanbul, TURKEY

8. Respect for soft tissue management and attention to
stable, rigid fixation with prolonged immobilization and
prolonged restricted weight bearing are essential for
successful treatment
Tahir OGUT Istanbul, TURKEY

9. Case
Y.K., 50y, M
4 months old fracture
Tahir OGUT Istanbul, TURKEY

10. Postop 3. month
Tahir OGUT Istanbul, TURKEY

11. CASE N.D.,78y, F
6 months after the first cast application
Tahir OGUT Istanbul, TURKEY

12. 10 days after removal of the first cast
Tahir OGUT Istanbul, TURKEY

13. Second cast application at the same center
Tahir OGUT Istanbul, TURKEY

14. She has been operated by us 3 months postoperatively
Tahir OGUT Istanbul, TURKEY

15. Postop 1. month
Tahir OGUT Istanbul, TURKEY

16. Postop 9. month
Tahir OGUT Istanbul, TURKEY

17. Tahir OGUT Istanbul, TURKEY

18. CASE H.G., 26y, F
Tahir OGUT Istanbul, TURKEY

19. Tahir OGUT Istanbul, TURKEY

20. Postop 3. month
Tahir OGUT Istanbul, TURKEY

21. Postop 6. month
Tahir OGUT Istanbul, TURKEY

22. THANK YOU
drtahirogut@gmail.com
Tahir OGUT Istanbul, TURKEY