scholarly journals Diabetic Ankle Fracture Complications: A Meta-Analysis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Laia Lopez-Capdevila ◽  
Juan Manuel Rios Ruh ◽  
Jorge Fortuño Vidal ◽  
Andres Eduardo Costa ◽  
Mario Alexandre Sanchez Mata ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Postoperative Management ◽  
Ankle Fractures ◽  
Diabetic Patients ◽  
Charcot Neuroarthropathy ◽  
Non Union ◽  
Major Complications ◽  
Increased Risk

Category: Ankle, Diabetes, Trauma Introduction/Purpose: Fractures in diabetic patients have a well-known increased risk of complications and this makes the decision to treat these fractures either surgically or conservatively a difficult choice. However, ankle fractures are mostly treated surgically because of their pattern and the postoperative management does not differ from those ankle fractures in non-diabetic patients. The following study aims to review the evident rate of complications following the treatment of an ankle fracture in diabetic patients and their matched controls. Methods: Searches of PubMed, Scopus, Cochrane and ISI Web of Knowledge were performed for studies published between the date of database inception and March 2018. An initial selection of 202 abstracts was performed by at least 2 different reviewers, of which 77 articles were selected to complete review. After following strict inclusion and exclusion criteria, only 17 papers were admitted to the final meta-analysis. Demographics patient characteristics and incidence of the overall and specific complications were extracted from each study selected and an odds ratio with a 95% confidence interval of each complication was calculated between the diabetic and non- diabetic groups. Major complications (infection, non-union, malunion, Charcot neuroarthropathy, amputation, death) were compared not only between the two main groups but also between subgroups (complicated diabetic and non-complicated diabetic patients, surgical and orthopaedic treatment). The statistics data was analysed by Stata 15. Results: There is a significant increased rate of complications after treating an ankle fracture orthopaedically or surgically in diabetic patients (OR 1.74, IC 95% 1.67 to 1.82). This risk is considerably higher when the ankle fracture is treated surgically (OR 5.14, IC 95% 2.79 -9.58). Among the complications in diabetic patients, the rate is greater in complicated diabetic patients (neuropathy, vasculopathy) compared to the non-complicated diabetic patients (OR 8, IC 95% 2.61 - 26.31). The main complication postoperative in ankle fracture described is infection, which is 7 times higher in diabetic patients in comparison to non-diabetic patients (OR 6.9, IC 95% 3.03 -15.73). The risk of amputation and/or non-union after an ankle fracture in diabetic patients is about 0.2%. Conclusion: This meta-analysis provides evidence that diabetic patients have a significant greater risk of presenting a complication after an ankle fracture. The rate of major complications (infection, malunion, non-union, amputation and death) is by far significantly higher among those diabetic patients treated surgically and even greater among complicated diabetic patients.

scholarly journals Risk Stratification for Ankle Fracture Complications in Diabetic Patients

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0025
Author(s):  
Kenneth Hunt ◽  
Daniel Moon ◽  
Joseph Morales ◽  
Amy Harlow
Keyword(s):  
Logistic Regression ◽  
Ankle Fracture ◽  
Major Complication ◽  
Wound Complication ◽  
Ankle Fractures ◽  
Diabetic Patients ◽  
Factors Associated ◽  
Major Complications ◽  
Increased Risk ◽  
Patients With Diabetes

Category: Diabetes Introduction/Purpose: While diabetes is a well-known risk factor for morbidity following surgical fixation of ankle fractures, it is likely that increased risk is related to specific diabetes-associated comorbidities. Compared to patients with uncomplicated diabetes, patients with complicated diabetes have higher risks of infection, overall complications, and a higher likelihood of needing revision surgery/arthrodesis. This suggests that the presence and severity of specific risk factors may help predict post-operative risks for diabetic ankle fracture patients and help guide treatment decisions. To date, no study has identified specific diabetes-associated factors and comorbidities which can pose an increased risk of complications for diabetic ankle fracture patients. We hypothesized that patients with diabetes-related comorbidities will suffer significantly more major complications following surgery for unstable ankle fractures compared to uncomplicated diabetics. Methods: We retrospectively reviewed all patients with diabetes treated surgically for ankle fracture at a University medical center over a 12-year period, examining patient and fracture characteristics, treatment method, and clinical and laboratory factors associated with complications. Outcome variables include time to union, wound complication, infection, hardware failure, and need for additional surgery following injury. The primary outcome was major complication, defined as the presence of one or more of the following: deep infection (as evidenced by hardware removal or I&D), amputation, malunion or non-union, skin graft, or wound complication (as evidenced by infection or dehiscence). Bivariate analyses and logistic regression were used to examine the relationships between specific complications and various clinical and demographic factors. A p-value of < 0.05 denotes statistical significance. Results: A total of 61 patients met inclusion criteria. Patient characteristics are depicted in Table 1. Bivariate analyses showed that when compared to diabetic patients without complications, patients who experienced major complications had a significantly higher rate of renal disease (p = 0.032) and retinopathy (p = 0.020), and significantly more hospital readmissions (p < 0.001). Factors associated with complications were determined by a logistic regression model. Age, sex, race, tobacco use and HgbA1C were not associated with increased risk of major complications. However, for each 1-unit increase in the Charlson Comorbidity Index (CCI) Score, there was a 40.6% increase in the likelihood of major complication among diabetic patients with ankle fractures (p = 0.025). Conclusion: Patients with diabetes-related comorbidities have a significantly higher risk of experiencing major complications following treatment of unstable ankle fractures. In this cohort, renal disease, retinopathy and higher CCI were found to be significantly associated with major complications. Interestingly, neuropathy, smoking, and HgA1C were not independent predictors of major complications in this cohort. These data will inform a multi-center prospective registry of patients with diabetes and ankle fractures, and ultimately the development of a risk tool to help guide clinical decision-making and post-operative care for diabetic patients at risk of major complication, re-admission, or re-operation following treatment for ankle fractures.

scholarly journals Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated with Diabetes Mellitus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0032
Author(s):  
Jennifer Liu ◽  
Junho Ahn ◽  
Dane Wukich ◽  
Katherine Raspovic
Keyword(s):  
Diabetes Mellitus ◽  
Internal Fixation ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Large Scale ◽  
Ankle Fractures ◽  
Unplanned Readmission ◽  
Diabetic Patients ◽  
Acs Nsqip ◽  
Increased Risk

Category: Ankle Introduction/Purpose: Ankle fractures are amongst the most common type of fracture injury in adults with an annual incidence of 187 fractures per 100,000 people in the United States. Previous groups have shown that diabetes mellitus (DM) is associated with a myriad of complications – including infection, malunion, and impaired wound healing – following open reduction internal fixation (ORIF) surgery for ankle fractures. However, to our knowledge there has not been a large-scale nationwide study on the rate of readmission, reoperation, and mortality associated with DM. The purpose of this study was to calculate the increased risk and odds ratios for 30-day postoperative readmission, reoperation, and mortality after ankle fracture ORIF. Methods: Patients who underwent ORIF for ankle fractures from 2006 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using Current Procedural Terminology codes. Median values along with 25th to 75th interquartile ranges (IQRs) were used to describe continuous variables and frequency (%) was used to describe categorical variables. Patient demographic factors along with 30-day postoperative outcomes were compared between those who had DM and those who did not have DM using the Mann-Whitney test or?2 test. 30-day postoperative unplanned readmission, unplanned reoperation, and mortality rates were compared in 2,044 patients with DM and 15,420 patients without DM. Crude odds ratios (OR) and adjusted ORs controlling for age differences were calculated for each parameter with a 95% confidence interval (CI). All statistical analyses were performed with a significance level of 0.05. Results: Patient factors and pre-operative laboratory statistics are summarized in Figure 1D, and the distribution of ankle fractures types are shown in Figure1A&B. Comparing patients with DM vs without DM, the rate of readmission was 4.35% vs 1.50%, rate of reoperation was 2.30% vs 0.75%, and rate of mortality was 0.73% vs 0.21%. As shown in Figure 1C, we found that patients with DM had a 2.66 times increased risk of readmission (CI: 1.99-3.52, p = 0.0001), 2.76 increased risk of reoperation (CI: 1.91-3.92, p = 0.0001), and a 2.34 increased risk of mortality (CI: 1.19-4.44, p = 0.0377). Interestingly, we also found a 22.06 increased risk of amputation (CI: 3.29-344.8, p = 0.0063) though the rate of amputation in both groups was very small. Conclusion: In this large-scale retrospective study we showed that the presence of diabetes mellitus significantly increases the risk of unplanned readmission, unplanned reoperation, and mortality within 30 days after ankle fracture ORIF surgery. Thus, patients with diabetes that require ORIF ankle surgery should be informed of their increased risk of complications and extra precautions should be taken to minimize risk. Further research in optimization of perioperative care for diabetic patients is crucial to reducing rates of complication. Large clinical databases such as ACS-NSQIP should endeavor to collect more parameters on diabetic patients to facilitate these studies.

scholarly journals Ankle fractures in diabetic patients

2020 ◽  
Vol 5 (8) ◽  
pp. 457-463
Author(s):  
Nikolaos Gougoulias ◽  
Hesham Oshba ◽  
Apostolos Dimitroulias ◽  
Anthony Sakellariou ◽  
Alexander Wee
Keyword(s):  
Ankle Fracture ◽  
Weight Bearing ◽  
Operative Management ◽  
Ankle Fractures ◽  
Diabetic Patients ◽  
Rigid Fixation ◽  
Charcot Neuroarthropathy ◽  
Fracture Management ◽  
Non Operative Management ◽  
Hindfoot Arthrodesis

Surgical complications are more common in patients with complicated diabetes (presence of inner organ failure, neuropathy). Of all patients undergoing ankle fracture fixation, approximately 13% are diabetic and 2% have complicated diabetes mellitus. Non-operative management of ankle fractures in patients with complicated diabetes results in an even higher rate of complications. Insufficient stability of ankle fractures (treated operatively, or non-operatively) can trigger Charcot neuroarthropathy, and result in bone loss, deformity, ulceration, and the need for amputation. Rigid fixation is recommended. Hindfoot arthrodesis (as primary procedure or after failed ankle fracture management) can salvage the limb in approximately 80% of patients. Early protected weight bearing can be allowed, provided rigid fixation without deformity has been achieved. Cite this article: EFORT Open Rev 2020;5:457-463. DOI: 10.1302/2058-5241.5.200025

Circulating Stem/Progenitor Cells as Prognostic Biomarkers in Macro- and Microvascular Disease: A Narrative Review of Prospective Observational Studies

2018 ◽  
Vol 25 (35) ◽  
pp. 4507-4517 ◽  
Author(s):  
Mauro Rigato ◽  
Gian Paolo Fadini
Keyword(s):  
Cardiovascular Disease ◽  
Progenitor Cells ◽  
Cardiovascular Events ◽  
Observational Studies ◽  
English Language ◽  
Microvascular Disease ◽  
Patient Characteristics ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Cell Phenotypes

Background: Circulating progenitor cells (CPCs) and endothelial progenitor cells (EPCs) are immature cells involved in vascular repair and related to many aspects of macro and microvascular disease. <p> Objective: We aimed to review studies reporting the prognostic role of CPCs/EPCs measurement on development of cardiovascular disease and microangiopathy. <p> Methods and Results: We reviewed the English language literature for prospective observational studies reporting the future development of cardiovascular disease or microangiopathy in patients having a baseline determination of CPCs/EPCs. We retrieved 34 studied reporting on cardiovascular outcomes and 2 studies reporting on microvascular outcomes. Overall, a reduced baseline level of CPCs/EPCs was associated with a significant increased risk of cardiovascular events, all-cause death, and onset/progression of microangiopathy. The most predictive phenotypes were CD34+ and CD34+CD133+. The main limitation was related to the high heterogeneity among studies in terms of patient characteristics and cell phenotypes. <p> Conclusion: The present review shows that a reduced level of circulating progenitor cells is a risk factor for the development of future cardiovascular events and death. In addition, low CPCs/EPCs levels predict the onset or worsening of microalbuminuria and retinopathy in diabetic patients.

Abstract 6238: Clarifying the Opportunities to Improve Survival After MI in Diabetic Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lance S Longmore ◽  
Kimberly J Reid ◽  
Mikhail Kosiborod ◽  
Frederick A Masoudi ◽  
Verna Welch ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Patient Characteristics ◽  
Psychosocial Health ◽  
Diabetic Patients ◽  
Biological Factors ◽  
Increased Risk ◽  
Wide Range ◽  
Patients With Diabetes ◽  
Multivariable Models ◽  
Adjusted Model

While diabetes is known to be associated with increased mortality after MI, whether these differences in outcome are due to patient characteristics, treatment, or other biological factors is unknown. We analyzed a contemporary cohort of MI survivors to comprehensively adjust for demographics, comorbidities, psychosocial, health status, clinical and treatment factors to determine if residual disparities in outcomes exist. We studied 2481 hospital survivors of MI in the prospective, 19-center PREMIER study (29% with diabetes). Multivariable models with sequential adjustment were employed to identify the extent to which variation in a wide range of patient characteristics (Figure ) accounted for differences in 3-year mortality in patients with and without diabetes. Unadjusted mortality was more than 2.5-fold greater for patients with diabetes (HR 2.55, 95% CI 2.08–3.14). Mortality was most attenuated by diabetes-related comorbidities (Figure ). The fully-adjusted model identified a significant, albeit attenuated, excess 3-year mortality among patients with diabetes (HR 1.57, 95% CI 1.22–1.99). Patients with diabetes experience a substantially increased risk for 3-year mortality after MI, even after accounting for a wide range of patient and treatment characteristics. This suggests that unmeasured, biologic variables associated with diabetes may mediate this difference. Further inquiry into the pathogenesis of diabetic cardiovascular disease is needed to identify new opportunities to improve the prognosis of patients with diabetes.

scholarly journals Clinical Considerations for Return to Driving a Car following a Total Knee or Hip Arthroplasty: A Systematic Review

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Annalisa Na ◽  
Kacy Richburg ◽  
Zbigniew Gugala
Keyword(s):  
Systematic Reviews ◽  
Hip Arthroplasty ◽  
Response Times ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Postoperative Management ◽  
Cochrane Library ◽  
Clinical Factors ◽  
Study Results ◽  
Meta Analyses

Aim. The purpose of this study is to systematically review patient characteristics and clinical determinants that may influence return to driving status and time frames following a primary TKA or THA and provide an update of the current literature. Methods. This review was completed per the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Final electronic database searches were completed in October 2019 in Medline/PubMed, Medline/OVID, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library using preselected search terms. Manuscripts of prospective and nonrandomized studies that examined the return to driving a car after a primary knee or hip arthroplasty patients were included. The Methodological Index for Non-Randomized Studies was used to measure study quality. Two authors selected studies and assessed their qualities. All disagreements were resolved through discussion and, as needed, a third reviewer. Data on study title, author(s), country, year, study design, sample size, inclusion and exclusion criteria, age, BMI, gender, statistical analyses, driving measure, follow-up time, surgical approach, laterality, and postoperative management were extracted from each study. Results. A total of 23 studies were eligible, including 12 TKA studies (n=654) with mean ages between 43 and 82 years, 9 THA studies (n=922) with mean ages between 34 and 85 years, and 2 combined TKA and THA (TKA, n=815; THA, n=685), yielded MINORS scores between 6 and 12. Most patients achieved or exceeded preoperative response times between 1 and 8 weeks following a TKA and 2 days to 8 weeks following a THA, and/or self-reported return to driving between 1 week and 6 months. Influences on return to driving time included laterality and pain, but gender was mixed. Discussion/Conclusions. Study results were consistent with previous systematic reviews in that return to driving a car after a primary TKA or THA is highly variable, and most commonly occurs around 4 weeks, but can range between 2 and 8 weeks. While various patient and clinical factors can influence return to driving for a TKA or THA, the most common contributing facts were pain and laterality. The heterogeneous nature of the studies prevented a meta-analysis for determining contributions of return to driving following a primary TKA or THA. Regardless, this study updates previous systematic reviews and presents insight on patient and clinical factors beyond generalized timeframes for return to driving a car. This information and results from future studies are essential to guide clinical recommendations and patient and clinician expectations for return to driving a car after a primary TKA or THA.

scholarly journals Post-natalizumab disease reactivation in multiple sclerosis: systematic review and meta-analysis

2019 ◽  
Vol 12 ◽  
pp. 175628641983780 ◽  
Author(s):  
Luca Prosperini ◽  
Revere P. Kinkel ◽  
Augusto A. Miravalle ◽  
Pietro Iaffaldano ◽  
Simone Fantaccini
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Disease Activity ◽  
Meta Analysis ◽  
Random Effect ◽  
Patient Characteristics ◽  
Increased Risk ◽  
Disease Reactivation ◽  
Definition Of ◽  
High Level

Background: Natalizumab (NTZ) is sometimes discontinued in patients with multiple sclerosis, mainly due to concerns about the risk of progressive multifocal leukoencephalopathy. However, NTZ interruption may result in recrudescence of disease activity. Objective: The objective of this study was to summarize the available evidence about NTZ discontinuation and to identify which patients will experience post-NTZ disease reactivation through meta-analysis of existing literature data. Methods: PubMed was searched for articles reporting the effects of NTZ withdrawal in adult patients (⩾18 years) with relapsing–remitting multiple sclerosis (RRMS). Definition of disease activity following NTZ discontinuation, proportion of patients who experienced post-NTZ disease reactivation, and timing to NTZ discontinuation to disease reactivation were systematically reviewed. A generic inverse variance with random effect was used to calculate the weighted effect of patients’ clinical characteristics on the risk of post-NTZ disease reactivation, defined as the occurrence of at least one relapse. Results: The original search identified 205 publications. Thirty-five articles were included in the systematic review. We found a high level of heterogeneity across studies in terms of sample size (10 to 1866 patients), baseline patient characteristics, follow up (1–24 months), outcome measures (clinical and/or radiological), and definition of post-NTZ disease reactivation or rebound. Clinical relapses were observed in 9–80% of patients and peaked at 4–7 months, whereas radiological disease activity was observed in 7–87% of patients starting at 6 weeks following NTZ discontinuation. The meta-analysis of six articles, yielding a total of 1183 patients, revealed that younger age, higher number of relapses and gadolinium-enhanced lesions before treatment start, and fewer NTZ infusions were associated with increased risk for post-NTZ disease reactivation ( p ⩽ 0.05). Conclusions: Results from the present review and meta-analysis can help to profile patients who are at greater risk of post-NTZ disease reactivation. However, potential reporting bias and variability in selected studies should be taken into account when interpreting our data.

scholarly journals Surgical versus non surgical management of Geriatrics ankle fractures. A Systematic Review and Meta-analysis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0014
Author(s):  
Abduljabbar Alhammoud ◽  
Karim Mahmoud Khamis ◽  
Mohamed Maged Mekhaimar
Keyword(s):  
Patient Satisfaction ◽  
Mortality Rate ◽  
Surgical Management ◽  
Conservative Management ◽  
Meta Analysis ◽  
Admission Rate ◽  
Ankle Fractures ◽  
Union Rate ◽  
Non Union ◽  
Surgical Group

Category: Trauma Introduction/Purpose: Ankle fractures are common orthopedics injuries especially in elderly. Bone quality, activity, and other comorbidities play a role in the management of ankle fracture in older age group. Conservative treatment by casting with or without reduction consider valid option whereas the open reduction and internal fixation still the stander of care for all age groups. This review aims to provide evidence-based difference between surgical and non-surgical management of geriatrics ankle fracture in regards to healing, complication and functional outcome. Methods: Relevant comparative studies in English literature were identified up to October 2017 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic-based search on MEDLINE (PubMed), EMBASE, Google Scholar and Cochrane databases, and hand searching of abstracts in orthopedics, trauma and foot and ankle journals. The research team systematically reviewed published studies according to the following criteria:(1) subjects whom sustained ankle fractures with age above 50 years;(2) the intervention was done through surgical management (open reduction and internal fixation) or conservative management (closed reduction and casting or casting alone) (3) the study reported at least one desirable outcome(non-union/mal-union rate, hospital stay, period on cast, mortality, re-admission rate, functional outcome, complication rate)(4) followed up at least one year after surgical /conservative management. The data analysis was done by Comprehensive meta-analysis software using a random-effect model and SPSS 22. Statistical heterogeneity across the studies was tested using I2. Results: The non-union rate in surgical group was significantly less than conservative group, (OR: 0.127, 95% CI: [0.055, 0.292], [P <0.001])and the mal-union was similarly less in surgical group (OR: 0.128, 95% CI: [0.063, 0.262], [P <0.001]). No difference in the hospital stays detected between two groups and similarly in re-admission rate. No difference in the period in cast reported between two groups. The return to pre-injury level was better in surgery group comparing to surgical one, whereas no difference in patient satisfaction was reported between two group. The mortality rate was less in the surgical group. The total number of skin complication was more in the conservative group.No difference in the incidence of DVT between two groups whereas the PE was in the surgical group. Conclusion: Geriatrics ankle fractures are challenging injury. The surgical management of such injuries showed superior results comparing to conservative management in terms of non-union /mal-union rate and return to pre-injury level with less mortality rate, whereas no difference in complications rate, hospital stay and patient satisfaction.

The Challenge of Lipid Management in Patients with Diabetes or Other Endocrine Disorders

2010 ◽  
Vol 7 (2) ◽  
pp. 92
Author(s):  
Alberico L Catapano ◽  
Liliana Grigore ◽  
Angela Pirillo ◽  
◽  
◽  
...  
Keyword(s):  
Statin Therapy ◽  
Meta Analysis ◽  
Diabetic Patients ◽  
Endocrine Disorders ◽  
Lipid Management ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Associated Risk Factors

Diabetes increases the risk of developing cardiovascular disease (CVD), and several guidelines suggest that subjects with diabetes are at high risk of developing CVD. The increased risk can be attributed, at least in part, to associated risk factors, including hypertension and dyslipidaemia. The role of statins in primary and secondary prevention of CVD is well established, and the positive effect has been clearly demonstrated also in patients with type 2 diabetes. A number of studies have evaluated the effect of statin therapy on incident CVD and shown that statin therapy produces a great reduction in cardiovascular risk, but a recent meta-analysis revealed a slight increase in the risk of developing diabetes. Such risk is, however, low, especially when compared with the reduction in cardiovascular events and should not interfere with the choice of treating diabetic patients with a cholesterol-lowering therapy.

scholarly journals Predictors of early complications following surgical treatment of geriatric ankle fracture

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Seung-Myung Choi ◽  
Byung-Ki Cho
Keyword(s):  
Surgical Treatment ◽  
Glycemic Control ◽  
Wound Infection ◽  
Ankle Fracture ◽  
Chronic Renal Disease ◽  
Multiple Logistic Regression Analysis ◽  
Serum Glucose ◽  
Ankle Fractures ◽  
Major Complications ◽  
Geriatric Ankle Fracture

Category: Ankle, Diabetes, Trauma Introduction/Purpose: Factors predicting complications after surgical treatment of geriatric ankle fractures include presence of various comorbidities such as diabetes, chronic renal disease. However, beyond the binary definition of presence or absence, further speci? c information of these comorbidities such as their chronicity, severity and/or perioperative laboratories have not been studied as risk factors for postoperative complications. The purpose of this study is to investigate the association between the measurements of comorbidities and complications within the? rst 30 days following surgical treatment of geriatric ankle fracture. Methods: A retrospective cohort study. From 2000 to 2015, we collected patient demographics, comorbidities-related data including laboratory values and complications within 30 days following open reduction and internal fixation of low energy ankle fractures in patients older than 65 years. Multiple logistic regression analysis was performed to determine factors affecting minor (super? cial wound infection, delayed wound healing, urinary tract infection, pneumonia), major complications (deep wound infection, loss of? xation, deep venous thrombosis, organ/space failure). Results: In total, 1,358 patients were included for analysis. The average age was 70.54 years (SD, 7.40). There were 895 (66%) females and 463 (34%) males. Baseline glucose concentrations >200 mg/dL (p < 0.001) and the mean 48 hour postoperative serum glucose concentrations >150 mg/dL (p < 0.001), history of taking wound compromising medications (p = 0.003) were signi? cantly associated with minor complications. Preoperative glycated hemoglobin (HbA1c) >6.5% (p < 0.001), estimated glomerular? ltration rate (eGFR) <45 mL/min/1.73 m2 (p < 0.001), dependent functional status and presence of two or comorbidities (p < 0.001) were statistically associated with major complications. Conclusion: poor glycemic control in the perioperative period, wound-compromising medications were associated with increased rates of minor complications, whereas poor chronic glycemic control (HbA1c), decreased renal function and vulnerability with multiple comorbid conditions were associated with major complications. Perioperative blood glucose management may prevent minor complications, whereas and mean serum glucose concentrations of 150 mg/dL and higher during this time period

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