The correlation between pre operator level of glucose and duration of hospitalization of diabetic patients with fractures

Abstract

Introduction. The incidence of traumatic fractures in diabetic patients is in a continuous rising and the successful management of fractures is a very difficult process. Risk assessment is an appropriate first step. A significant attention must be paid on the severity of the patient’s systemic disease process and the level of glucose. For patients with complicated diabetes and a high level of glucose - the risk of any complication is 3.8 times bigger compared with the group with uncomplicated diabetes, especially if we look for an increased risk of infection, malunion, delayed union, nonunion, Charcot arthropathy, and impaired wound healing. Aim of the study. To establish the correlation between pre operator level of glucose and duration of hospitalization of diabetic patients with fractures as well as the rate of complications. Materials and methods. In this study were included 64 patients with fracture and type 2 Diabetes, 42 (65.6%) women and 22(34.4%) men hospitalized in the 1stand 2ndDepartment of the Clinical Hospital of Orthopedics and Traumatology from January 2019 to October 2019. All patients were treated surgically, due to the fracture of a limb, average age was 51 years, with age limits 43-78 years. The patients were classified according to the age of diabetes, glycemic control at the moment of hospitalization, superior or inferior limb. Results. All 64 patients had a surgical intervention, including intramedullary nailing, ORIF, ring fixator (Ilizarov) or external fixator. 58 (90.6%) patients were hospitalized due to inferior limb fracture, from anamnesis mostly because of falls. 46 patients - with uncomplicated diabetes, and without end-stage organ disease and glucose level less than 10 mmol/l demonstrated improved outcomes, faster tissue healing (they were discharged from hospital approx after 9 days) and a lower rate of complications (only 6 of them). The other 18 patients with preoperator glucose above 10 mmol/l, 14 of them had malunion/delayed union/nonunion or impaired wound healing. The average period of hospitalization was 17 days. Patients with diabetes over 13 years - had a higher glucose level and higher complication rate. Conclusions. In diabetes, the regeneration of soft tissues is a big challenge, and what at first glance appears to be a routine fracture it may be turned into a difficult case requiring additional strategies to avoid limb loss. Regardless of which treatment method one chooses for a fracture in a patient with diabetes, an important component to preventing complications is tight glycemic control and minimal incisions because maintaining a proper physiologic glucose levels helps encourage wound healing, reducing also and the days of hospitalization.