Healing time of foot and ankle fractures in patients with diabetes mellitus: Literature review and report on own cases

Background: It is widely believed that diabetes mellitus affects fracture healing. This assumption is based on a single case report by Cozen (1972), and has never proved by scientific data ever since. Objectives: To extract from the literature the current knowledge on the outcome of closed ankle and foot fractures in diabetics, and to review own cases from patients' charts. Outcome criteria was the healing time. Methods: The literature was searched using MEDLINE for the years 1983-2003, under the key words "diabetes and fractures". Own cases of ankle fractures (28 diabetic, and 17 non-diabetic control cases), and of foot fractures (35 diabetic cases with Charcot-fractures) were analysed in retrospect. Results: The literature search yielded 466 hits, but not one single prospective, controlled study on fracture healing time in diabetics. Three papers contained data on healing time of ankle fractures, according to which ankle fractures in diabetics take only a little longer to heal than in non-diabetics. This is consistent with our own cases: in the diabetic subjects (HbA1c 8.5%), the fractures had healed within 3.5 months (median), versus 3 months in the non-diabetic subjects. According to 3 papers found by MEDLINE search, Charcot-fractures of the foot will heal within 3-7 months; our own cases healed within 3-5 months (median). According to the literature, treatment of Charcot foot fractures is delayed by 3 months, due to polyneuropathy, as in our cases. In non-diabetic subjects treated immediately after trauma, foot fractures will heal within 3 months (according to the literature). Conclusion: The present data suggest that diabetes mellitus in general does not affect the healing of foot and ankle fractures, provided effective delivery of standard treatment in time. Diabetic complications may affect the outcome. Prospective controlled trials in fracture healing in diabetics are needed to confirm the present evaluation.