Review
Copyright ©The Author(s) 2015.
World J Orthop. Apr 18, 2015; 6(3): 331-339
Published online Apr 18, 2015. doi: 10.5312/wjo.v6.i3.331
Table 1 Complications of diabetes potentially affecting orthopaedic surgery patients
Retinopathy
Visual impairment leading to falls
Peripheral neuropathy
Balance issues
Gait abnormalities
Lack of protective sensation
Increased risk of surgical site infection
Increased risk of nonunion
Peripheral artery disease
Impaired lower extremity blood supply leading to faulty healing
End stage renal disease
Metabolic bone disease
Anemia of chronic disease
Poorly controlled diabetes (hyperglycemia)
Increased risk of surgical site infection
Impaired bone and soft tissue healing
Table 2 Impact of diabetes on orthopaedic surgical subspecialties
Foot and ankle surgery
Increased risk of surgical site infection
Increased risk of nonunion, malunion and hardward failure
Increased risk of neuropathic ulcers
Spine surgery
Increased risk of surgical site infection
Increased risk of nonroutine discharges
Sports medicine
Impaired healing of soft tissues (ligaments and tendons)
Spontaneous necrosis of muscle
Total joint arthroplasty
Increased risk of surgical site infection
Increased risk of nonroutine discharges
Upper extremity
Increased risk of nerve compression syndromes
Increased risk of overuse syndromes
Inferior outcomes in rotator cuff repair and frozen shoulder
Table 3 Take home messages for orthopaedic surgeons treating diabetic patients
Optimize the patient’s medical care preoperatively
Strive for long term glycemic control of HbgA1c ≤ 8%
Thorough preoperative workup for cardiovascular disease
Identify anemia if present and treat accordingly if major blood loss is anticipated (i.e., spine surgery or total joint surgery)
Thorough assessment of the vascular system preoperatively
If an abnormal examination is present proceed with non-invasive testing and vascular consultation
Perioperative care
Strive for inpatient glycemic control as recommended by major societies
Pre-meal glucose of < 140 mg/dL
Random glucose of < 180 mg/dL
Avoid hypoglycemia!!
Glucose levels of > 200 mg/dL have been associated with increased rates of complications in orthopaedic patients
Recognize that patients with poorly controlled diabetes and comorbidities are at increased for postoperative complications
Cardiovascular complications
Myocardial infarction
Stroke
Deep vein thrombosis and pulmonary embolism
Infection
Surgical site
Urinary tract
Pneumonia
Iatrogenic pressure ulcers
Pad bony prominences such as the sacrum and heels
Noninfectious complications
Hardward failure
Nonunion or malunion
Impaired wound healing
Inform patients that local injections of corticosteroids (trigger point injections, epidural steroid injections, etc.) will cause a temporary elevation in serum glucose for 24-48 h