Comparative Outcomes of Lower Extremity Fractures in Patients With Type 1 and Type 2 Diabetes: A Retrospective Database Analysis.

IF 1.3 4区医学 Q3 ORTHOPEDICS

Orthopedics Pub Date : 2026-07-01 Epub Date: 2026-07-08 DOI:10.3928/01477447-20260612-01

Thomas E Olson, Christopher Hamad, Joshua Wiener, Trevor Lloyd, Jeannie Park, Autreen Golzar, Aliyah Walker, Rene Chun, John Adams, Nicholas Bernthal, Christopher Lee, William L Sheppard

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引用次数: 0

Abstract

Background: Diabetes mellitus (DM) is a major risk factor for adverse outcomes following orthopedic trauma. Although both type 1 (T1DM) and type 2 (T2DM) diabetes mellitus increase complication risk after lower extremity fracture fixation, their relative impacts remain poorly characterized.

Materials and methods: We performed a retrospective cohort analysis to compare postoperative outcomes in patients with T1DM and T2DM who underwent surgical fixation of lower extremity fractures. Propensity score matching was performed within anatomical fracture subgroups based on age, sex, race, body mass index, hemoglobin A_1c, and nicotine dependence. Outcomes were compared using appropriate statistical tests and survival analysis.

Results: A total of 10,464 patient-fracture encounters across 4 anatomic subgroups met inclusion criteria. After propensity score matching within each subgroup, 1,776 matched pairs (3,552 encounters) were analyzed. T1DM patients experienced higher rates of adverse outcomes compared to T2DM patients, with the greatest differences observed for infection (tibia: 7.3% vs 3.1%, P = .009; foot/ankle: 9.8% vs 1.8%, P < .001), amputation (femur: 2.9% vs 0.0%, P = .001; tibia: 2.6% vs 0.0%, P = .001), and mortality (hip: 21.8% vs 15.1%, P = .003; femur: 12.3% vs 4.4%, P < .001; tibia: 9.9% vs 2.5%, P < .001; foot/ankle: 7.5% vs 2.0%, P < .001). These risks appeared to increase distally, with the highest complication rates seen in the tibial and foot/ankle subgroups.

Conclusions: T1DM confers a distinctly higher risk of infection, limb loss, and mortality following operative fixation of lower extremity fractures compared to T2DM, despite similar baseline characteristics after matching. These findings highlight the need for diabetes-subtype-specific perioperative management strategies to optimize outcomes in this high-risk population.

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1型和2型糖尿病患者下肢骨折的比较结果：回顾性数据库分析

背景：糖尿病（DM）是骨科创伤后不良后果的主要危险因素。尽管1型（T1DM）和2型（T2DM）糖尿病都增加了下肢骨折固定后并发症的风险，但它们的相对影响仍不清楚。材料和方法：我们进行了一项回顾性队列分析，比较T1DM和T2DM患者接受下肢骨折手术固定的术后结果。根据年龄、性别、种族、体重指数、血红蛋白A1c和尼古丁依赖，在解剖骨折亚组中进行倾向评分匹配。采用适当的统计检验和生存分析对结果进行比较。结果：4个解剖亚组共有10464例骨折患者符合纳入标准。在每个亚组内进行倾向评分匹配后，分析了1 776对（3 552次）配对。与T2DM患者相比，T1DM患者的不良结局发生率更高，其中感染（胫骨：7.3% vs 3.1%, P = 0.009；足/踝关节：9.8% vs 1.8%, P < 0.001）、截肢（股骨：2.9% vs 0.0%, P = 0.001；胫骨：2.6% vs 0.0%, P = 0.001）和死亡率（髋关节：21.8% vs 15.1%, P = 0.003；股骨：12.3% vs 4.4%, P < 0.001；胫骨：9.9% vs 2.5%, P < 0.001；足/踝关节：7.5% vs 2.0%, P < 0.001）差异最大。这些风险似乎在远端增加，胫骨和足/踝关节亚组的并发症发生率最高。结论：尽管匹配后的基线特征相似，但与T2DM相比，T1DM在下肢骨折手术固定后感染、肢体丧失和死亡率的风险明显更高。这些发现强调需要针对糖尿病亚型的围手术期管理策略来优化这一高危人群的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Orthopedics 医学-整形外科

CiteScore

2.20

自引率

0.00%

发文量

160

审稿时长

3 months

期刊介绍： For over 40 years, Orthopedics, a bimonthly peer-reviewed journal, has been the preferred choice of orthopedic surgeons for clinically relevant information on all aspects of adult and pediatric orthopedic surgery and treatment. Edited by Robert D''Ambrosia, MD, Chairman of the Department of Orthopedics at the University of Colorado, Denver, and former President of the American Academy of Orthopaedic Surgeons, as well as an Editorial Board of over 100 international orthopedists, Orthopedics is the source to turn to for guidance in your practice. The journal offers access to current articles, as well as several years of archived content. Highlights also include Blue Ribbon articles published full text in print and online, as well as Tips & Techniques posted with every issue.