{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:07:08Z","timestamp":1787314028111,"version":"build-2736575974"},"reference-count":21,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2003,11,1]],"date-time":"2003-11-01T00:00:00Z","timestamp":1067644800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2003,11]]},"abstract":"<jats:p>Background: Surgical treatment of ankle fractures in patients with diabetes mellitus is associated with a high complication rate. Diabetic patients with peripheral neuropathy are a particularly difficult group to treat because of their inability to sense deep infection, repeat trauma, and wound complications. The purpose of this study was to evaluate a protocol that included transarticular fixation and prolonged, protected weightbearing in the treatment of unstable ankle fractures in diabetic patients with peripheral neuropathy and loss of protective sensibility. Methods: The authors retrospectively reviewed the records of 15 patients with diabetes mellitus, unstable ankle fractures (AO classification 44B), and loss of protective sensibility confirmed via testing with a 5.07 Semmes-Weinstein monofilament. Retrograde trans-calcaneal-talar-tibial fixation using large Steinmann pins or screws in conjunction with standard techniques of open reduction and internal fixation was used. The postoperative treatment protocol included: 1) short leg, total contact casting and nonweightbearing status for 12 weeks; 2) removal of the intramedullary implants between 12 and 16 weeks; 3) application of a walker boot or short leg cast with partial weightbearing for an additional 12 weeks; and 4) transition to a custom-molded ankle-foot orthosis (AFO) or custom total-contact inserts in appropriate diabetic footwear. Results: The major complication rate for all fractures was 25% (4\/16) and for closed fractures was 23% (3\/13). These are lower than previously reported rates between 30% (3\/10) and 43% (9\/21) for diabetic patients with and without neuropathy. The amputation rate for all fractures was 13% (2\/16) and for closed fractures alone was 8% (1\/13). These are similar to previously reported rates of 10% (2\/10) to 20% (2\/21). There were no deaths or Charcot malunions in this series. The combination of transarticular fixation and prolonged, protected weightbearing provided 13 of 15 patients with a stable ankle for weightbearing. Conclusion: Although these fractures remain a treatment challenge, this study presents a successful, multidisciplinary protocol for treatment of unstable ankle fractures in the most challenging group of diabetic patients \u2013 those with loss of protective sensibility.<\/jats:p>","DOI":"10.1177\/107110070302401106","type":"journal-article","created":{"date-parts":[[2017,1,10]],"date-time":"2017-01-10T20:52:14Z","timestamp":1484081534000},"page":"838-844","source":"Crossref","is-referenced-by-count":84,"title":["A Protocol for Treatment of Unstable Ankle Fractures Using Transarticular Fixation in Patients with Diabetes Mellitus and Loss of Protective Sensibility"],"prefix":"10.1177","volume":"24","author":[{"given":"Mihir M.","family":"Jani","sequence":"first","affiliation":[{"name":"Saint Louis, MO"},{"name":"Department of Orthopaedic Surgery, Barnes-Jewish Hospital, The Washington University School of Medicine, Saint Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Ricci","sequence":"additional","affiliation":[{"name":"Saint Louis, MO"},{"name":"Department of Orthopaedic Surgery, Barnes-Jewish Hospital, The Washington University School of Medicine, Saint Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Borrelli","sequence":"additional","affiliation":[{"name":"Saint Louis, MO"},{"name":"Department of Orthopaedic Surgery, Barnes-Jewish Hospital, The Washington University School of Medicine, Saint Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Barrett","sequence":"additional","affiliation":[{"name":"Saint Louis, MO"},{"name":"Department of Orthopaedic Surgery, Barnes-Jewish Hospital, The Washington University School of Medicine, Saint Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey E.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Saint Louis, MO"},{"name":"Department of Orthopaedic Surgery, Barnes-Jewish Hospital, The Washington University School of Medicine, Saint Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2003,11,1]]},"reference":[{"key":"bibr1-107110070302401106","doi-asserted-by":"publisher","DOI":"10.1177\/107110079902001103"},{"key":"bibr2-107110070302401106","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-196547070-00004"},{"key":"bibr3-107110070302401106","first-page":"164","volume":"120","author":"Childress HM","year":"1976","journal-title":"Clin. 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Singapore"},{"key":"bibr12-107110070302401106","first-page":"S17","volume":"49","author":"Mayfield JA","year":"2000","journal-title":"J. Fam. Pract."},{"key":"bibr13-107110070302401106","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.80B4.8648"},{"key":"bibr14-107110070302401106","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/76.1.68"},{"key":"bibr15-107110070302401106","first-page":"45","volume-title":"AO Principles of Fracture Management","author":"Murphy WM","year":"2000"},{"key":"bibr16-107110070302401106","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199274020-00012"},{"key":"bibr17-107110070302401106","unstructured":"17. Perry M, Taranow WS, Manoli AII: Multiple syndesmotic fixation for neuropathic ankle fractures with failed traditional fixation. Proceedings of the Annual Winter Meeting of the American Orthopaedic Foot and Ankle Society, Dallas, TX 2002."},{"key":"bibr18-107110070302401106","first-page":"46","volume":"32","author":"Scioscia TN","year":"2003","journal-title":"Am. J. 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