Author: Dr. Gordon Slater
One of the most serious complications of diabetes is the development of severe lower limb and foot problems that cause minor injuries, such as blisters or ulcers, rapidly progressing to severe infections, gangrene, and, in some cases, limb amputations.
Here, the preservation of the affected limb is a critical concern, and external frames can assist in efforts to salvage diabetic limbs. This article explores the uses, benefits, procedures, and challenges of diabetes and external frames.
External Frames in Diabetes Care
In orthopedic treatments, external frames or fixations are devices made of pins, wires, and plates that are inserted surgically to support and immobilize injured or diseased bones. Just as they are used to help a fractured bone, these devices can also help preserve a diabetic limb in several ways, including:
● Infection Control: In diabetic patients with open wounds, infections are a grave concern. External fixation devices allow easy wound access and cleaning without frequent dressing changes or further surgical procedures.
● Stabilization: For severe deformities or fractures in diabetic limbs, external fixation can provide essential stability to prevent further damage and promote healing. This, in turn, can help preserve limb function, allowing patients to maintain mobility and independence.
● Offloading Pressure: In diabetic foot ulcers, offloading pressure from the affected area is crucial for wound healing. External fixation frames can redistribute weight and pressure, reducing stress on vulnerable regions.
● Correcting Deformities: Diabetes can lead to structural deformities in the foot and ankle. External fixation allows surgeons to gradually correct these deformities, restoring a more functional and pain-free foot.
External Frames Procedures
Several techniques are available for fixing external frames, such as the Ilizarov method, circular frames, and hybrid fixation. The technique ultimately used depends on the condition of the limb in question and the diabetic patient’s health.
● Ilizarov Method: A well-known external fixation technique, the Ilizarov method involves the placement of metal rings and wires around the limb, allowing for precise adjustments over time. It is typically used to correct deformities and promote bone healing.
● Circular Frames: Circular external fixation frames, similar to those used in the Ilizarov method, are applied around the limb to provide stabilization, promote wound healing, and facilitate deformity correction.
● Hybrid Fixation: Some cases may require a combination of internal and external fixation devices, referred to as hybrid fixation. This approach combines the strengths of both methods to achieve optimal outcomes.
Challenges of Diabetes and External Frames
While external frames can assist in diabetic limb salvage, these devices are not without their challenges. Firstly, patients must actively participate in the care and maintenance of external fixation devices. This can be especially demanding, requiring full commitment and compliance.
Moreover, there is still a risk of infection associated with the use of pins and wires, again requiring patients to be vigilant and consistent in follow-up care.
Additionally, wearing an external frame can be psychologically difficult for patients. Not only do these devices have the potential to be uncomfortable, but their visible nature may inhibit public and social interactions.
Conclusion
Diabetes-related foot complications are a serious concern, and external fixations are a viable option to preserve limb function and avoid amputations. However, outcomes vary from patient to patient as they depend on a patient’s specific circumstances, condition, and health.
To learn more about diabetes and external frames and whether it is an option for your case, an experienced orthopedic surgeon can provide accurate recommendations for your specific case.