Diabetes (DM) increases fracture risk, and bone quality depends on type diabetes type, duration, and other comorbidities. Diabetes is associated with a 32% increased relative risk (RR) of total fractures and 24% increased RR of ankle fractures compared with patients without DM. Type 2 DM is associated with a 37% increased RR of foot fractures compared with patients without DM. The incidence of ankle fractures in the general population is 169/100,000 per year, while foot fractures occur less frequently, with an incidence of 142/100,000 per year. Biomechanical properties of bone are negatively impacted by stiff collagen, contributing to the increased risk of fragility fractures in patients with DM. Systemic elevation of proinflammatory cytokines, such as tumor necrosis factor-alpha (TNFα), interleukin-1β (IL-1β), and interleukin 6 (IL-6), impact bone healing in patients with DM. Fractures in patients with DM, can be associated with poorly regulated levels of RANKL (receptor activator of nuclear transcription factor kappa-b ligand) leading to prolonged osteoclastogenesis, and net bone resorption. One of the most salient factors in treating fractures and dislocations of the foot and ankle is to recognize the difference between patients with uncomplicated and complicated DM. Complicated diabetes is defined as 'end organ damage', and for the purposes of this review, includes patients with neuropathy, peripheral artery disease (PAD) and/or chronic renal disease. Uncomplicated diabetes is not associated with 'end organ damage'. Foot and ankle fractures in patients with complicated DM pose challenges, and surgery is associated with increased risks of impaired wound healing, delayed fracture healing, malunion, infection, surgical site infection, and revision surgery. While patients with uncomplicated DM can be treated like patients without DM, patients with complicated DM require close follow-up and robust fixation methods should be considered to withstand the anticipated prolonged healing period. The aims of this review are as follows: (1) to review pertinent aspects of DM bone physiology and fracture healing, (2) to review the recent literature on treatment of foot and ankle fractures in patients with complicated DM, and (3) to provide treatment protocols based on the recent published evidence.

中文翻译：

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糖尿病患者足部和踝部的骨折和脱位：文献综述。

糖尿病 (DM) 会增加骨折风险，骨骼质量取决于糖尿病的类型、持续时间和其他合并症。与没有糖尿病的患者相比，糖尿病与总骨折相对风险 (RR) 增加 32% 和踝关节骨折 RR 增加 24% 相关。与非 DM 患者相比，2 型 DM 足部骨折的 RR 增加 37%。一般人群踝关节骨折的发生率为每年 169/100,000，而足部骨折的发生频率较低，为每年 142/100,000。骨骼的生物力学特性受到僵硬胶原蛋白的负面影响，导致 DM 患者发生脆性骨折的风险增加。促炎细胞因子的系统性升高，例如肿瘤坏死因子-α (TNFα)、白细胞介素 1β (IL-1β) 和白细胞介素 6 (IL-6)，影响 DM 患者的骨愈合。DM 患者的骨折可能与 RANKL（核转录因子 kappa-b 配体的受体激活剂）水平调节不佳有关，导致破骨细胞生成延长和净骨吸收。治疗足踝骨折和脱位的最重要因素之一是识别无并发症和复杂 DM 患者之间的差异。复杂性糖尿病被定义为“终末器官损伤”，为了本综述的目的，包括患有神经病变、外周动脉疾病 (PAD) 和/或慢性肾病的患者。无并发症的糖尿病与“终末器官损伤”无关。复杂 DM 患者的足部和踝部骨折带来挑战，手术会增加伤口愈合受损、骨折愈合延迟、畸形愈合、感染、手术部位感染和翻修手术的风险。虽然无并发症的 DM 患者可以像没有 DM 的患者一样接受治疗，但复杂的 DM 患者需要密切随访，并且应考虑采用稳健的固定方法来承受预期的延长愈合期。本综述的目的如下：(1) 回顾 DM 骨骼生理学和骨折愈合的相关方面，(2) 回顾关于复杂 DM 患者足踝骨折治疗的最新文献，以及 (3)根据最近发表的证据提供治疗方案。虽然无并发症的 DM 患者可以像没有 DM 的患者一样接受治疗，但复杂的 DM 患者需要密切随访，并且应考虑采用稳健的固定方法来承受预期的延长愈合期。本综述的目的如下：(1) 回顾 DM 骨骼生理学和骨折愈合的相关方面，(2) 回顾关于复杂 DM 患者足踝骨折治疗的最新文献，以及 (3)根据最近发表的证据提供治疗方案。虽然无并发症的 DM 患者可以像没有 DM 的患者一样接受治疗，但复杂的 DM 患者需要密切随访，并且应考虑采用稳健的固定方法来承受预期的延长愈合期。本综述的目的如下：(1) 回顾 DM 骨骼生理学和骨折愈合的相关方面，(2) 回顾关于复杂 DM 患者足踝骨折治疗的最新文献，以及 (3)根据最近发表的证据提供治疗方案。