{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:06:45Z","timestamp":1787580405325,"version":"build-2736575974"},"reference-count":16,"publisher":"MDPI AG","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    To evaluate complications and risk factors for nonunion in patients with diabetes after ankle fracture.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    We conducted a retrospective study of 139 patients with diabetes and ankle fractures followed for 1 year. We evaluated the incidence of wounds, infections, nonunions, Charcot\u2019s arthropathy, and amputations. We determined Fracture severity (unimalleolar, bimalleolar, trimalleolar), nonunion, and Charcot\u2019s arthropathy from radiographs. Nonunion was defined as a fracture that did not heal within 6 months of fracture. Analysis of variance was used to compare continuous variables, and \u03c7\n                    <jats:sup>2<\/jats:sup>\n                    tests to compare dichotomous variables, with \u03b1 = 0.05. Logistic regression was performed with a binary variable representing nonunions as the dependent variable.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Complications were common: nonunion (24.5%), Charcot\u2019s arthropathy (7.9%), wounds (5.2%), wound site infection (17.3%), and leg amputation (2.2%). Patients with nonunions were more likely to be male (55.9% versus 29.5%;\n                    <jats:italic>P<\/jats:italic>\n                    = .005), have sensory neuropathy (76.5% versus 32.4%;\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001), have end-stage renal disease (17.6% versus 2.9%;\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001), and use insulin (73.5% versus 40.1%;\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001), \u03b2-blockers (58.8% versus 39.0%;\n                    <jats:italic>P<\/jats:italic>\n                    = .049), and corticosteroids (26.5% versus 9.5%;\n                    <jats:italic>P<\/jats:italic>\n                    = .02). Among patients with nonunion, there was an increased risk of wounds (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.46\u20137.73), infection (OR, 2.04; 95% CI, 0.72\u20135.61), amputation (OR, 7.74; 95% CI, 1.01\u2013100.23), and long-term bracing (OR, 9.51; 95% CI, 3.8\u201323.8). In the logistic regression analysis, four factors were associated with fracture nonunion: dialysis (OR, 7.7; 95% CI, 1.7\u201335.2), insulin use (OR, 3.3; 95% CI, 1.5\u20137.4), corticosteroid use (OR, 4.9; 95% CI, 1.4\u201318.0), and ankle fracture severity (bimalleolar or trimalleolar fracture) (OR, 2.5; 95% CI, 1.1\u20135.4).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    These results demonstrate risk factors for nonunions: dialysis, insulin use, and fracture severity after ankle fracture in patients with diabetes.\n                  <\/jats:p>","DOI":"10.7547\/20-246","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T12:17:37Z","timestamp":1666009057000},"source":"Crossref","is-referenced-by-count":6,"title":["Incidence of Complications and Risk Factors for Nonunion After Ankle Fracture in Diabetes Mellitus"],"prefix":"10.3390","volume":"112","author":[{"given":"Lawrence A.","family":"Lavery","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Lavery","sequence":"additional","affiliation":[{"name":"Statistic Consulting, Aurora, CO."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyson","family":"Green","sequence":"additional","affiliation":[{"name":"Imperial Health\u2013Center for Orthopaedics, Lake Charles, LA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Hunt","sequence":"additional","affiliation":[{"name":"Orthopaedic & Spine Center of the Rockies, Fort Collins, CO."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Malone","sequence":"additional","affiliation":[{"name":"Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dane","family":"Wukich","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"J Bone Joint Surg Br","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1302\/0301-620X.87B4.15724","article-title":"Ankle fractures in patients with diabetes mellitus","volume":"87","author":"Jones KB","year":"2005","unstructured":"Jones KB, Maiers-Yelden KA, Marsh JL, et al: Ankle fractures in patients with diabetes mellitus. 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