Diabetes: a major risk factor in trauma and orthopaedic surgery

Diabetes mellitus is a growing epidemic and places a great burden on healthcare services in the UK. Trauma and orthopaedic surgeons find themselves dealing with patients with diabetes on an increasingly regular basis. Any level of surgical trauma can lead to a physiological stress response involving the hypothalamic–pituitary–adrenal axis. The resultant hormone releases can have negative effects on glucose homeostasis. General risks of operating on patients with diabetes include endothelial dysfunction, postoperative sepsis, impaired wound healing and cerebral ischaemia. Polytrauma patients with diabetes have a significantly greater risk of mortality than patients who do not have diabetes. Non-union of fractures is more common in patients with diabetes, as are deep-seated postoperative infections. National guidelines from the Joint British Diabetes Societies for Inpatient Care advise how to manage patients with diabetes in the perioperative period. Trauma and orthopaedic surgeons must be aware of these increased risks of operating and ensure that patients are involved in surgical decision making.