Israel Medical Association Journal

Background: Diabetic foot (DF) is a dangerous complication of diabetes mellitus (DM). Modern treatment modalities and good organization of care can improve prognosis.

Objectives: To analyze results of DF treatment in a tertiary care setting and the degree of implementation of international guidelines in practice.

Methods: We conducted a retrospective analysis of 90 patients treated for DF ulcers/wounds in our center (May–December 2023). Thirty-five patients received only outpatient care. The median age was 65 (37–90) years, 96% had type 2 DM.

Results: Median wound duration was 29 (1–1461) days. Previous treatment was conducted by a family doctor in 30%, at a local wound clinic in 7%, by other medical specialists in 27%, or by the patient/relatives in 29%. At this stage off-loading devices were prescribed for 37%, and 35% were referred to a vascular surgeon. Limb ischemia occurred in 44 patients (49%), revascularization was conducted for 16 patients. At 6 months, healing rates were 48%. Minor or major amputation rates were 4% and 5%, respectively; 6% died, 29% stayed unhealed, and 8% were lost to follow-up. Multivariable analysis revealed independent predictors of non-healing (ethnic group and impossibility of revascularization) and of amputation (previous major amputation, presence of osteomyelitis, and white blood cell count).

Conclusions: To prevent diabetes-related amputations, healthcare professionals must prioritize preventive care, provide regular podiatry services for high-risk patients, ensure early specialist treatment for any foot ulcer, implement international guidelines at all levels of DF care, and increase the capacity of secondary wound clinics and access to revascularization.

Background: Little is known regarding the impact of the coronavirus disease-2019 (COVID-19) pandemic on the incidence of hip fractures among older adults

Objectives: To compare the characteristics of patients with a hip fracture following a fall during the COVID-19 pandemic year and during the preceding year.

Methods: We conducted a retrospective cohort study of older patients who had undergone surgery for hip fracture repair in a major 495-bed hospital located in northern central Israel following a fall. Characteristics of patients who had been hospitalized in 2020 (pandemic year, n=136) and in 2019 (non-pandemic year, n=151) were compared.

Results: During the pandemic year, patients were less likely to have fallen in a nursing facility, to have had muscle or balance problems, and to have had a history of falls and fractures following a fall. Moreover, the average length of stay (LOS) in the hospital was shorter; however, the average time from the injury to hospitalization was longer. Patients were less likely to have acquired a postoperative infection or to have died. During the pandemic year, postoperative infection was only associated with prolonged LOS.

Conclusions: The COVID-19 pandemic may have had a positive impact on the behavior of older adults as well as on the management of hip fracture patients. However, healthcare providers should be aware of the possible reluctance to seek care during a pandemic. Moreover, further research on the impact of the change in management during COVID-19 on hip fracture survival is warranted