Effect of Diabetes Mellitus Type II on Long Bones Fractures Healing

Ali Sadighi, Mohammadreza Bazavar, Mitra Niafar, Ali Tabrizi, Nilsa Doorandish

Abstract


Introduction: Fracture healing is a complex process where synthesis and activation of a cascade of cells and molecules collaborate and participate in regeneration of the fractured bones. There are several factors involved in nonunion of fractured bones. Endocrine and metabolic diseases are regarded as factors causing nonunion of fractured bones. The present study aims at evaluating effect of diabetes type II, as an important and prevalent metabolic disease, on results of surgical treatment of long bones fractures. Method: This case-control study was conducted on 74 patients with isolated fracture of tibia and femur shafts resulting from low-energy trauma. In this study, 50 patients with definite diagnosis of diabetes were compared with 24 metabolically health persons considering age, gender, type of fracture, and treatment method. The diabetic patients were classified in two groups considering their insulin or oral agent. Level of hs-CRP inflammatory marker was also determined in these patients. Union rate and duration as well as relation between inflammatory marker and union rate were studied.

Results: Prevalence of nonunion and delayed union were seen in 8 (32%) and 2 (8%) patients with orally-treated diabetes, respectively. It was 3 (12%) in diabetes patients treated with insulin.

However, there was not any case of nonunion in the health group. There was a statistically significant difference between these groups. According to the regression model, hs-CRP level played a significant role considering nonunion prediction (P=0.001, Odd’s Ratio=3.4, CI95%:1.4-4.8). Also, type of diabetes treatment had a significant role in predicting nonunion (P=0.04, Odd’s Ratio=0.6, CI95%:0.3-1.4). Duration of being affected by diabetes did not play any important role in nonunion prediction.

Conclusion: Prevalence of nonunion in patients with diabetes suffering from fracture and undergoing orthopedic surgery is higher than healthy people. It seems that increase of inflammatory markers and oral agents therapy plays an important role in causing and predicting of nonunion in these patients.

 

Keywords: Anti-diabetic; Nonunion; Inflammatory Factors


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