Factors Associated with Nonunion, Delayed Union, and Malunion in Foot and Ankle Surgery in Diabetic Patients

Naohiro Shibuya, Jon M. Humphers, Benjamin L. Fluhman, Daniel C. Jupiter

Research output: Contribution to journalArticlepeer-review

75 Scopus citations


The incidence of bone healing complications in diabetic patients is believed to be high after foot and ankle surgery. Although the association of hyperglycemia with bone healing complications has been well documented, little clinical information is available to show which diabetes-related comorbidities directly affect bone healing. Our goal was to better understand the risk factors associated with poor bone healing in the diabetic population through an exploratory, observational, retrospective, cohort study. To this end, 165 diabetic patients who had undergone arthrodesis, osteotomy, or fracture reduction were enrolled in the study to assess the risk factors associated with nonunion, delayed union, and malunion after elective and nonelective foot and/or ankle surgery. Bivariate analyses showed that a history of foot ulcer, peripheral neuropathy, and surgery duration were statistically significantly associated with bone healing complications. After adjusting for other covariates, only peripheral neuropathy, surgery duration, and hemoglobin A1c levels >7% were significantly associated statistically with bone healing complications. Of the risk factors we considered, peripheral neuropathy had the strongest association with bone healing complications.

Original languageEnglish (US)
Pages (from-to)207-211
Number of pages5
JournalJournal of Foot and Ankle Surgery
Issue number2
StatePublished - Mar 2013
Externally publishedYes


  • Bone
  • Charcot foot
  • Complication
  • Diabetes mellitus
  • Hyperglycemia
  • Peripheral neuropathy
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Factors Associated with Nonunion, Delayed Union, and Malunion in Foot and Ankle Surgery in Diabetic Patients'. Together they form a unique fingerprint.

Cite this