Introduction: Diabetes mellitus (DM) accompanies approximately 30% of hip/knee arthroplasty cases and more than doubles the risk of periprosthetic joint infection (PJI), wound failure, thromboembolism, and readmission. Consensus on perioperative glycemic management remains limited. Methods: The PubMed/MEDLINE database (January 2000 to March 2025) was queried for English language studies of adults with DM undergoing primary or revision hip or knee arthroplasty. Combinations of “arthroplasty,” “diabetes,” “HbA1c,” “fructosamine,” “glycated albumin,” “GLP1,” “SGLT2,” and “negative-pressure wound therapy” identified 162 eligible articles. Each was evaluated using the GRADE framework. Results: Complication odds increased when preoperative HbA1c exceeded 7.5% or fasting glucose exceeded 115 mg/dL. Short-term biomarkers, fructosamine ≥292 µmol/L or glycated albumin >15.5%, predicted PJI and wound failure more accurately than HbA1c. Protocols that continued metformin, titrated insulin, and introduced preoperative GLP-1 receptor agonists reduced PJI by 43% and 90-day readmissions by 32%. In poorly controlled or obese patients, negative-pressure wound therapy with silver dressings lowered superficial infection rates by 35-40%. Discussion: Adopting dynamic biomarker panels, prioritizing GLP-1–based regimens, and applying targeted incision management can meaningfully curb diabetes-related complications after arthroplasty. Prospective trials should refine biomarker cutoffs, weigh SGLT-2 risks against transfusion benefits, and define cost-effective wound care pathways.

Case: A 32-year-old man presented with a type II open both-bone forearm fracture and segmental bone loss because of complete extrusion of a diaphyseal fragment (3 cm) of ulna. The patient presented to our level 1 trauma center after a motor vehicle collision. The extruded segment underwent sterilization and immediate reimplantation with internal fixation approximately 6 hours after arrival. Our patient achieved union by 7-month follow-up, demonstrated excellent functional outcomes, and was free from infection at 1-year follow-up. Conclusion: In select cases, successful reimplantation can be achieved by meticulous debridement, sterilization, and immediate reimplantation with internal fixation.