Michael Serhal, MD
Dr. Samir Serhal Hospital, Rabieh
With about to 12 to 15% of orthopedic patients, being diabetic, orthopedic surgeons are commonly involved in managing diabetic patients in both outpatient and inpatient setting. Diabetes mellitus (DM) is one of the most common chronic medical conditions in the world that leads to a variety of complications, and the incidence of this disease is increasing globally with an estimate that, by the year 2030, it will affect 440 million patients. Poorly controlled diabetes negatively impacts healing and leads to multiple complications that adversely affect the outcome of orthopedic surgeries.
Musculo-skeletal manifestations of diabetes
Diabetic patients experience higher rates of infectious and non-infectious complications with a high predilection for the foot and ankle, largely due to its consequences, such as neuropathy and peripheral artery disease. Among those complications, 15% to 25% of patients will develop a foot ulcer at some point, with a dramatic risk of foot infection and even amputation.
Patients with DM also often have limitation of motion in the foot and ankle, resulting in alterations of foot biomechanics with an increased risk of falling. Bone mineral alteration, with a reduction in bone formation, result in diminished fracture healing, and increase revision of surgery rates. The burden of DM also affects other sub-specialties of orthopedic surgery, among them trauma, with an increased risk of hip fracture and total joint replacement (arthroplasty) where higher rates of pulmonary embolism and infection are reported. Concerning the hand, diabetes induces conditions such as carpal tunnel syndrome, Dupuytren disease, trigger digits and limited joint mobility and in spine surgery patients have longer hospital stays and need for more blood transfusion. Sports medicine and even pediatric orthopedics are also affected by the complications of (DM) overall, hyperglycemia due to diabetes unfavorably impacts all the outcomes of musculo-skeletal disorders.
Diabetes mellitus is associated with negative outcomes across the spectrum of orthopedic surgery, making it essential to optimize preoperative and postoperative medical management for those patients. Higher infection rates, longer hospital stays, and increased costs have all been observed in poorly controlled diabetics. However patients with uncomplicated DM and optimal glycemic control have similar outcomes to patients without DM, making it essential for orthopedic surgeons in assisting inpatient glycemic management, as well as, optimizing long term glycemic control, and increasing awareness and conducting regular screening of at-risk patients to improve diabetes diagnosis.